Placenta Previa - Nursing Case Study

by - June 15, 2020

DESCRIPTION:
Placenta Previa is when the placenta is implanted abnormally in the lower part of the uterus and it is one of the most common cause of painless bleeding in the third trimester. It has 4 degrees implantation namely, lower lying placenta in which the implantation is lower than in the upper portion, a marginal implantation where the placenta edge approaches that of the cervical os, partial placenta previa is when the implantation occludes a portion of the cervical os, and total placenta previa where the implantation totally obstructs the cervical os. This condition usually occurs when the placenta is forces to spread to find an adequate exchange surface.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
A pregnant woman who has this kind of condition usually experience painless, bright red bleeding because it cannot stretch to accommodate the shape of the cervix, and sudden enough to make a woman scare, however, it may stop as abruptly as it began. But for some other women, it may slow after the initial hemorrhage but linger as continuous spotting.

DIAGNOSTIC AND LABORATORY TEST:
Placenta previa usually detected through the use of ultrasound. Through a routine sonogram, many low – lying placentas migrate upwards to a noncervical position. This condition is usually explained to woman and cautioned to call the healthcare provider for any sign of vaginal bleeding.

RISK FACTORS:
There are several risk factors associated with this condition like the increased parity, advanced maternal age like beyond 35 years old, when a women had past cesarean births and past uterine curettage, multiple gestation, and perhaps a male fetus.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Fear related to outcome of pregnancy after episode of placenta previa bleeding
Deficient Fluid Volume related to active blood loss secondary to disrupted placental implantation
Decreased Cardiac Output related to altered contractility
Ineffective Tissue Perfusion related to decreased hemoglobin concentration in blood and hypovolemia
Impaired Fetal Gas Exchange related to altered blood flow

NURSING CARE PLAN:
Fear related to outcome of pregnancy after episode of placenta previa bleeding
Deficient Fluid Volume related to active blood loss secondary to disrupted placental implantation
Decreased Cardiac Output related to altered contractility
NURSING MANAGEMENT / INTERVENTION:
Since there is bleeding it is a must to ensure an adequate blood supply to a pregnant woman and fetus by placing the woman immediately on bed rest in a side – lying position. It is also a must to assess the duration of the pregnancy, time of bleeding began, woman’s estimation of the amount of blood, if there was accompanying pain, color of the blood, anything she did to stop the bleeding, if there were a prior episodes of bleeding during the pregnancy, and if she had a cervical surgery for premature cervical dilatation before. Inspect the perineum for bleeding and estimate the present rate of blood loss by weighing the perineal pads every hour. A test called Apt or Kleihauer – Betke test can be used in order to detect whether the blood is from the mother or from the fetus. Vital signs should be monitored in order to check for any signs of hypovolemic shock. Blood pressure should be assess continuously for every 5 to 15 minutes with an electronic cuff.

MEDICAL / SURGICAL MANAGEMENT:
It is not allowed to do a pelvic or rectal examination if a pregnant woman is experiencing a painless bleeding because the placenta previa might tear the placenta further and it can initiate massive hemorrhage that can be fatal to both mother and the baby. An external monitoring equipment is needed to attach to the woman in order to record the fetal heart sounds and uterine contractions. Administering intravenous fluid, as prescribed, preferably with a large – gauge catheter to allow blood replacement through the same line. A vaginal birth is always the safest choice for the infant that is why it is a must to determine the exact location of the placenta. If the previa is under 30% by abdominal or intravaginal ultrasound, the fetus might be born through a normal delivery but if it’s over 30%, it would be hard for the fetus to get past the placenta so the safest choice to do is cesarean birth. 

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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