Chapter 7 - Placenta Previa

What is placenta previa?

Occurs when the placenta abnormally implants in the lower segment of the uterus near o over the cervical os instead of attaching to the fundus. Abnormal implantation results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface.

What are the 3 types of Placenta Previa?

-complete or total
-incomplete or partial
-marginal or low lying

What is Complete or total Placental Previa?

when the cervical os is completely covered by the placental attachment

What is the Incomplete or Partial Placenta Previa

when the cervical os is only partially covered by the placental attachment

What is the Marginal or Low Lying?

when the placenta is attached in the lower uterine segment but does not reach the cervical os

What are the risk factors for Placenta Previa?

-previous placenta previa
-uterine scarring (previous cesarean birth, curettage, endometritis)
-maternal age greater than 35 to 40 years
-multifetal gestation
-multiple gestations or closely spaced pregnancies
-smoking

Subjective Data seen on a patient with Placenta Previa

painless, bright red vaginal bleeding during the 2nd or 3rd trimester

Objective Data seen on a patient with Placenta Previa

-uterus soft, relaxed and nontender with normal tone
-fundal height greater than usually expected for gestational age
-fetus in a breech, oblique or transverse position
-reassuring fetal heart rate
-vital signs within normal limits
-decreasing urinary output may be a better indicator of blood gloss

Laboratory Tests done to diagnose a patient with Placenta Previa

-HgB and Hct for blood loss assessment
-CBC
-Blood type and Rh
-coagulation profile
-Kleihauer Betke test (used to detect fetal blood in maternal circulation)

Diagnostic Procedure done to diagnose a patient with Placenta Previa

-transabdominal or transvaginal ultrasound for placement of the placenta
-fetal monitoring for fetal well being assessment

Nursing Actions to care for a patient with Placenta Previa

-assess for bleeding, leakage, or contractions
-assess fundal height
-perform Leopold maneuvers (fetal position and presentation)
-refrain from performing vaginal exams (may exacerbate bleeding)
-adminster IV fluids, blood products, and medications as prescribed
*Corticosteroids: such as betamethasone (Celestone), promote fetal lung maturation if delivery is anticipated (cesarean birth)
-have oxygen equipment available in case of fetal distress

Health Promotion and Disease Prevention for a patient with Placenta Previa

-bed rest
-nothing inserted vaginally