PLACENTA PREVIA Definition: • •
Is an abnormal low implantation of the placenta in proximity to the internal cervical os. Placenta previa is a condition in which the placenta attaches to the uterine wall in the lower portion of the uterus and covers all or part of the cervix.
Classification of Placenta Previa 1. 2. 3.
Total PreviaPrevia- the the placenta placenta complet completely ely covers covers the the internal internal cervic cervical al os. Partial Partial PreviaPrevia- the the placenta placenta covers covers a part of the intern internal al cervical cervical os. os. Marginal Marginal PreviaPrevia- the edge edge of the placenta placenta lies lies at the margin margin of the internal internal cervica cervicall os and may be exposed exposed during dilatation.
4.
Low-lying placenta- the placenta is implanted in the lower uterine segment but does not reach to the internal os of the cervix.
Risk factors 1. 2. 3. 4. 5.
Adva Advanc nced ed mate matern rnal al age age multiparity prev previo ious us uter uterin ine e surg surger ery y large placenta placenta (multiple (multiple gestation gestation,, erythrobl erythroblastos astosis) is) mater aterna nall sm smoki oking
4.
5. 6. 7. 8.
If bleeding bleeding is more more profuse profuse client is hospital hospitalized ized on bed rest rest with BRP, BRP, IV access; access; labs: labs: Hgb and Hct, Hct, urinalysis urinalysis,, blood group and type and cross match for 2 units of blood hold, possible transfusions; goal is to maintain the pregnancy fetal maturity. No vaginal vaginal exams exams are performed performed except except under under special special conditions conditions requiri requiring ng a double set-up set-up for immedia immediate te cesarean birth should hemorrhage result. Low lying lying or marginal marginal previas previas may allowed allowed to deliver deliver vaginally vaginally if the the fetal head head acts as tampon tamponade ade to prevent prevent hemorrhage. Cesarean Cesarean birth, birth, often often with vertic vertical al uterine uterine incision, incision, is used used for for total placent placenta a previa. previa. Steroid Steroid shots shots may be given given to to help help mature mature the the baby's baby's lungs. lungs.
Anatomy and Physiology
Normal Placenta During Childbirth Process of placental growth and uterine wall changes during pregnancy 1. 2. 3.
The placen placenta ta grows grows with with the the placent placental al site site during during pregnancy. pregnancy. During During pregnancy pregnancy and early early labor the the area of the placent placental al site probably probably changes changes little, little, even even during during uterine contractions. The semiri semirigid, gid, nonco noncontrac ntractile tile place placenta nta cannot cannot alter alter its surfac surface e area. area.
Anatomy of the uterine/placental compartment at the time of birth
PATHOPHYSIOLOGY OF PLACENTA PREVIA
Painless Vaginal Bleeding
Ultrasound Risk Factors Advanced Maternal Age
Previous Uterine Multiparity
Surgery
Complete Previa Partial Previa
Large Placenta Maternal (Multiple Gestation, Smoking
Erythroblastosis)
Marginal Previa Low-lying placenta Bleeding Stops Fetus Stable
Bed Rest
Observe
Assessment S- “Dinudugo ako at tila marami nang lumalabas na dugo sa akin!” as verbalized by the Pt. OBleeding Episodes (amount, duration) Facial Grimace due of Pain or no complaint of pain Abdomen soft/hard when palpated Manifest Body Weakness Low BP Increased HR Decreased RR Fetal HR >120160 bpm Decreased Urine Out Increased Urine Concentration Pale, Cool Skin Increased Capillary Refill (specify) Lab. Results
Diagnosis Fluid Volume Deficient r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Scientific Rationale Fluid volume deficient is a state in which an individual is experiencing decreased intravascular, interstitial and/or intracellular fluid. Active Blood Loss or Hemorrhage due to disrupted placental implantation during pregnancy may manifest signs and symptoms of fluid vol. deficient that may later lead to hypovolemic shock and cause maternal and fetal death. Reference: Maternal and Child Health Nursing by Adele Piliteri Nursing Diagnosis Pocketbook by Mary Ellen Murray, R.N., Ph.D, Leslie D. Atkinson, R.N., M.S.N. Nurse’s Pocket Guide 9th Edition by Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Geissier-Murr
Outcomes After rendering nursing intervention and medical assistance, Pt. will exhibit signs of adequate fluid balance during pregnancy.
Nursing Care Plan Nursing Intervention Diagnostic Assess color, odor, consistency and amount of vaginal bleeding; weigh pads Assess hourly intake and output.
Scientific Rationale
Provides information about active bleeding versus old blood, tissue loss and degree of blood loss Provides information about maternal and fetal physiologic compensation to blood loss
Assess baseline data and note changes. Monitor FHR.
Assessment provides information about possible infection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms.
Assess abdomen for tenderness or rigidity- if present, measure abdomen at umbilicus (specify time interval)
Detecting increased in measurement of abdominal girth suggests active abruption
Assess SaO2, skin color, temp, moisture, turgor, capillary refill (specify frequency)
Assessment provides information about blood vol., O2 saturation and peripheral perfusion
Assess for changes in LOC: note for complaints of thirst or apprehension
To detect signs of cerebral perfusion
Therapeutic Provide supplemental O2 as ordered via facemask or nasal cannula @ 10-12 L/min.
Intervention increases available O2 to saturate decreased hemoglobin
Initiate IV fluids as ordered (specify fluid type and rate).
For replacement of fluid vol. loss
Position Pt. in supine with hips elevated if ordered or left lateral position.
Position decreases pressure on placenta and cervical os. Left lateral position improves placental perfusion
Monitor lab. Work as obtained: Hgb & Hct, Rh and type, cross match for 2 units RBCs, urinalysis, etc. Scheduled for ultrasound as ordered.
Lab. Work provides information about degree of blood loss; prepares for possible transfusion. Ultra sound provides info about the cause of bleeding
Determine if Pt. has any objections to blood transfusions- inform physician.
Pt. may have religious beliefs related to accepting blood products
Administer blood transfusion as ordered with client consent.
To provides replacement of blood components and volume
Monitor closely for transfusions reaction
To prevent for Potentially life-threatening allergic reaction may result from incompatible blood
Provide emotional support; keep Pt. and family informed of findings and continuing plan of care. Administered prenatal vitamins and iron as ordered: provide a diet high in iron: lean meats, dark green leafy vegetables, eggs, and whole grains. Prepare Pt. for cesarean birth if ordered when severe hemorrhage, abruption, complete previa at term is already experience.
Support and information decrease anxiety and help Pt. and family to anticipate what might happen next. Proper diet and vitamins replace nutrient losses from active bleeding to prevent anemia- iron is a necessary component of hemoglobin
Cesarean Birth may be necessary to resolve the hemorrhage or prevent fetal or maternal injury.
Evaluation Pt. has no further vaginal bleeding; Blood pressure is maintained at at least 100/60 mm Hg; PR <100 bpm; fetal HR is maintained at 120-160 bpm; UO >30ml/hr.
