Placenta Previa
Placenta Previa is the development of the placenta in the lower uterine segment, partially or completely covering the internal cervical os.
Types of Placenta Previa:
- Complete or Total Placenta Previa – the placenta completely covers the internal os when the cervix is fully dilated.
- Partial Placenta Previa – the placenta partially covers the internal os.
- Marginal Placenta Previa – the edge of the placenta is lying at the margin of the internal os.
- Low lying Placenta Previa – the placenta implants near the internal os, its edges can be felt by the examining finger on IE.
Predisposing Factors:
- Multiparity (80% of affected clients are multiparous)
- Multiple Pregnancy
- Advanced maternal age (older than 35 years old in 33% of cases)
- Previous cesarean section and abortion
- Uterine incisions
- Prior placenta previa
Clinical Manifestations:
- Bleeding that is painless, sudden and profuse during the end of second trimester, or during third trimester.
- Soft, nontender abdomen; relaxes between contractions, if present.
- FHR stable and within normal limits.
- Normal uterine tone
- Leopold’s maneuver: the fetus is in breech, oblique or transverse position.
Laboratory and Diagnostic Study Findings:
- Transabdominal ultrasonography confirms suspicion of placenta previa.
- CBC: decreased Hb and HCT levels if bleeding is present.
Nursing Management:
- Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh saturated perineal pads to assess maternal blood loss.
- Maintain bedrest and elevate the head of the bed.
- Provide fluid administration, usually with lactated Ringer’s solution, through a large-bore IV line to maintain fluid balance.
- Consider cesarean delivery if the placenta previa is more than 30% or if excessive bleeding occurs.
- Measure fundal height to assess for rising fundus, which may reveal concealed bleeding.
- Disallow rectal or vaginal examinations, to minimize the danger of bleeding.
- Prepare the patient and family emotionally and physically for delivery.
- Observe for meconium in the amniotic fluid; may indicate fetal distress.
- Provide emotional support to the patient and family.
Nursing Care Plan – Placenta Previa
