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:

  1. Complete or Total Placenta Previa – the placenta completely covers the internal os when the cervix is fully dilated.
  2. Partial Placenta Previa – the placenta partially covers the internal os.
  3. Marginal Placenta Previa – the edge of the placenta is lying at the margin of the internal os.
  4. Low lying Placenta Previa – the placenta implants near the internal os, its edges can be felt by the examining finger on IE.

types of placenta

Predisposing Factors:

  1. Multiparity (80% of affected clients are multiparous)
  2. Multiple Pregnancy
  3. Advanced maternal age (older than 35 years old in 33% of cases)
  4. Previous cesarean section and abortion
  5. Uterine incisions
  6. Prior placenta previa 

Clinical Manifestations:

  1. Bleeding that is painless, sudden and profuse during the end of second trimester, or during third  trimester.
  2. Soft, nontender abdomen; relaxes between contractions, if present.
  3. FHR stable and within normal limits.
  4. Normal uterine tone
  5. Leopold’s maneuver: the fetus is in breech, oblique or transverse position.

Laboratory and Diagnostic Study Findings:

  1. Transabdominal ultrasonography confirms suspicion of placenta previa.
  2. CBC: decreased Hb and HCT levels if bleeding is present.

Nursing Management:

  1. Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh saturated perineal pads to assess maternal blood loss.
  2. Maintain bedrest and elevate the head of the bed.
  3. Provide fluid administration, usually with lactated Ringer’s solution, through a large-bore IV line to maintain fluid balance.
  4. Consider cesarean delivery if the placenta previa is more than 30% or if excessive bleeding occurs.
  5. Measure fundal height to assess for rising fundus, which may reveal concealed bleeding.
  6. Disallow rectal or vaginal examinations, to minimize the danger of bleeding.
  7. Prepare the patient and family emotionally and physically for delivery.
  8. Observe for meconium in the amniotic fluid; may indicate fetal distress.
  9. Provide emotional support to the patient and family.

 

Nursing Care Plan – Placenta Previa

What Do You Think?