Nursing Care Plan - Placenta Previa

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Placenta previa is the development of placenta in the lower uterine segment, partially or completely covering the internal cervical os. The cause is unknown, but a possible theory states that the embryo will implant in the lower uterine segment if the deciduas in the uterine fundus is not favorable. Complications are immediate hemorrhage, shock, and maternal death; fetal mortality; and post partum hemorrhage.

Predisposing Factors:

1. Multiparity (80% of affected clients are multiparous)
2. Advanced maternal age (older than 35 years old in 33% of cases
3. Multiple gestation
4. Previous Cesarean birth
5. Uterine Incisions
6. Prior placenta previa ( incidence is 12 times greater in women with previous placenta previa)

Nursing Management

1. Ensure the physiologic well-being of the client and fetus

a. Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh perineal pads before and after use to estimate blood loss.

b. Observe for shock, which is characterized by a rapid pulse, pallor, cold moist skin and a drop in blood pressure

c. Monitor the FHR

d. Enforce strict bed rest to minimize risk to the fetus

e. Observe for additional bleeding episodes.

2. Provide client and family teaching

a. Explain the condition and management options. To ensure an adequate blood supply to the mother and fetus, place the woman at bed rest in a side-lying position. Anticipate the order for a sonogram to localize the placenta. If the condition of mother or fetus deteriorates, a cesarean birth will be required.

b. Prepare the client for ambulation and discharge ( may be within 48 hours of last bleeding episode)

c. Discuss the need to have transportation to the hospital available at all times.

d. Instruct the client to return to the hospital if bleeding recurs and to avoid intercourse until after the birth.

e. Instruct the client on proper handwashing and toileting to prevent infection.

3. Address emotional and psychosocial needs

a. Offer emotional support to facilitate the grieving process, if needed

b. After birth of the newborn, provide frequent visits with the newborn so that the mother can be certain of the infant’s condition

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