PLACENTA PREVIA

IN PLACENTA PREVIA, THE PLACENTA IS IMPLANTED IN THE LOWER

UTERINE SEGMENT RATHER THAN THE UPPER PORTION OF THE UTERUS
THIS IMPLANTATION MAY BE ON A PORTION OF THE LOWER SEGMENT
OR OVER THE INTERNAL CERVICAL OS. AS THE LOWER UTERINE SEGMENT
CONTRACTS AND DILATES IN THE LATER WEEKS OF PREGNANCY, THE
PLACENTAL VILLI ARE TORN FROM THE UTERINE WALL, EXPOSING THE
UTERINE SINUSES AT THE PLACENTAL SITE. BLEEDING BEGINS, BUT
BECAUSE ITS AMOUNT DEPENDS ON THE NUMBER OF SINUSES EXPOSED,
INITIALLY IT MAY BE EITHER SCANTY OR PROFUSE .
 CATEGOR OF PLACENTA PREVIA:

 Low lying: The placenta is implanted in the lower uterine segment in

proximity to but not covering the os
 Partial: The internal os is partially covered.
 Marginal: The edge of the placenta is covered
 Complete: The internal os is completely covered
 THE CAUSE OF PLACENTA PREVIA

 The cause of placenta previa is unknown, Statistically, it

occurs in 0.3% to 0.5% of all women in the United States (Joy,
2015),Women of African descent and Asian women may be at
higher risk, although there is conflicting research in this area.
Women who have undergone a prior cesarean birth are at
higher risk for placenta previa.The risk further increases the
numbers of cesarean births Advanced matremal age has been
identified as a risk factor with increased risk being directly
correlated to increases in maternal age
 Fetal/Neonatal Implications
 The prognosis for the fetus depends on the extent of placenta previa, in cases
of a marginal previa or a low-lying placenta, the woman may be allowed to
labor. Changes in the fetal heart rate (FHR) and meconium staining of the
amniotic fluid may be apparent, in a profuse bleeding episode, the fetus is
compromised and suffers some hypoxia. FHR monitoring is imperative when
the woman is admitted, particularly if a vaginal birth is anticipated because
the presenting part of the fetus may obstruct the flow of blood from the
placenta or umbilical cord. If nonreassuring fetal status occurs, cesarean birth
is indicated. Women who are diagnosed with a complete or partial previa will
undergo a cesarean birth because the risk of intrapartum hemorrhage is high.
After birth blood sampling should be done to determine whether the
intrauterine bleeding episodes of the woman have caused anemia in the
newborn
 CLINICAL THERAPY
The goal of medical care is to identify the cause of bleeding and to
provide treatment that will ensure birth of a mature newborn.
Indirect diagnosis is made by localizing the placenta through tests
that require no vaginal examination such as a transabdominal
ultratiound scan .Until placenta previa is ruled out, vaginal
exeminabons should never be performed on a woman with
bleeding because the examiner's fingers could perforate the
placenta if cervical dilation has occurred . Once the placenta previa
is rule out , a vaginal examination can be performed with a
speculum to determine the cause of bleeding ( such as cervical
lesions)
The differential diagnosis of placental or cervical bleeding takes careful
consideration. Partial separation of the placenta may also present with
painless bleeding, and true placenta previa may not demonstrate overt
bleeding until labor begins, thus confusing the diagnosis.

Care of the woman with painless late-gestational bleeding depends on (1) the
week of gestation during which the first bleeding episode occurs and (2) the
amount of bleeding.
If the pregnancy is less than 37 weeks' gestation, expectant management is
used to delay birth until about 37 weeks' gestation to allow the fetus time to
mature.
Expectant management involves the following:
1. Providing bed rest with bathroom privileges as long as the woman is not
bleeding
2. Performing no vaginal examination
3. Monitoring blood loss, pain, and uterine contractility
4. Evaluating FHR with an external fetal monitor
5. Monitoring maternal vital signs
6. Performing a complete laboratory evaluation: hemoglobin, hematocrit, Rh
factor, and urinalysis7. Providing (lactated Ringer solution)
7. Provides intravenous fluids (lactate ringer solution)
8. Having 2 units of cross-matched blood available for transfusion.

If frequent, recurrent, or profuse bleeding persists, or if fetal well-being appears

threatened, a cesarean birth may be needed.
Nursing ManagementFor the Woman With Placenta Previa
Nursing Assessment and Diagnosis
Assessment of the woman with placenta previa must be ongoing to
prevent or treat complications that are potentially lethal to the mother
and fetus.
Painless, bright red vaginal bleeding is the most accurate diagnostic sign of
placenta previa. If this sign develops during the last 3 months of pregnancy,
placenta previa should always be considered until ruled out by ultrasound
examination. The first bleeding episode is generally scanty. If no vaginal
examinations are performed, it often subsides spontaneously However,
each subsequent hemorrhage is more profuseThe uterus remains soft, if
labor begins, it relaxes fully between contractions. The FHR usually remains
stable unless profuse hemorrhage and maternal shock occur. As a result of
the placement of the placenta, the fetal presenting part is often unengaged,
and transverse lie is common.
It is important to assess blood loss, pain, and uterine contractility both
subjectively and objectively. Maternal vital signs and the results of blood
and urine tests provide additional data about the woman’s condition.
Evaluate the FHR with continuous external fetal monitoring. Observe and
verify the family’s ability to cope with the anxiety associated with an
unknown outcome.

Nursing diagnoses that may apply include the following:

Fluid Volume: Deficient, related to hypovolemia secondary to
excessive blood loss
Gas Exchange, Impaired, of the fetus related to decreased
blood volume and maternal hypotension
Anxiety related to concern for own personal status and the
baby’s safety
Planning and Implementation

Monitor the woman and her fetus to determine the status of the
bleeding and the responses of the mother and baby. Do the
following tasks:
1.Take vital signs.2.Record intake and output.3.Perform ongoing
continuous fetal monitoring 4.Perform ongoing continuous uterine
activity monitoring with external tocodynamometer.5.Prepare a
whole-blood setup to be ready for intravenous infusion.6.Establish a
patent intravenous line before caregivers undertake any invasive
procedures.7.Monitor maternal vital signs every 15 minutes in the
absence of hemorrhage and every 5 minutes with active
hemorrhage.
Provision of emotional support for the family is an important nursing care
goal. During active bleeding, the assessments and management are
directed toward physical support. However, emotional aspects need to be
addressed simultaneously. Explain the assessments and treatment
measures needed. Provide time for questions, and act as an advocate in
obtaining information for the family Emotional support can also be offered
by staying with the family and using touch.

Promotion of neonatal physiologic adaptation is another important nursing

responsibility. Check the newborn's hemoglobin, cell volume, and
erythrocyte count immediately and then monitor them closely. The
newborn may require oxygen, administration of blood, and admission into a
special-care nursery.
Evaluation : Anticipated outcomes of nursing care include
the following:-
The cause of hemorrhage is recognized promptly and
corrective measures are taken
.The woman's vital signs remain in the normal rangeAny
other complications are recognized and treated early.
The woman and her baby have a safe labor and birth.
The family understands what has happened and the
implications and associated problems of placenta previa
Student Name: sara alaia

Student ID:202111245