THE CARE OF WOMAN WITH PLACENTA PREVIA

Definition of Placenta Previa

The placenta is an organ that develops inside the uterus during pregnancy. It works to provide oxygen and nutrition to the baby and to remove waste. The placenta connects to your baby through the umbilical cord. Typically, the placenta is attached to the top or side of the inner wall of the uterus.

Placenta previa is a problem of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix. Brief overview of the condition

With placenta previa, the placenta attaches lower in the uterus. This results in some portions of the placental tissue covering the cervix. It can result in bleeding during the pregnancy or during or after delivery. Importance of proper care during pregnancy with placenta previa

Proper care during pregnancy with placenta previa is crucial for the well-being of both the expectant mother and the baby. Changes in the uterus and placenta during pregnancy may lead to the problem correcting on its own. If it doesn't, the baby is delivered by cesarean section (C-section).

Three different types of placenta previa

• Complete previa

• Partial previa

• Marginal previa

Complete previa

occurs when the placenta is completely covering the cervix.

Partial placenta previa

is when placenta is partially covering the cervix

Marginal placenta previa

is near the cervix opening but not covering it.

The cause of placenta previa is unknown, so there is no way to fully prevent it during your pregnancy, but there are common risk factors to be aware of such as:

• Have had a baby

• Have had a previous C-section delivery

• Have scars on the uterus from a previous surgery or procedure

• Had placenta previa with a previous pregnancy

• Are pregnant after having an assisted reproductive technology (ART) procedure for treating infertility

• Are carrying more than one fetus

• Are age 35 or older

• Smokes

• Use cocaine

Signs and symptoms of placenta previa

• The main sign of placenta previa is bright red vaginal bleeding, usually without pain, after 20 weeks of pregnancy. Sometimes, spotting happens before an event with more blood loss.

• The bleeding may occur with prelabor contractions of the uterus that cause pain. The bleeding may also be triggered by sex or during a medical exam. For some women, bleeding may not occur until labor. Often there is no clear event that leads to bleeding.

Diagnosis and screening procedures

• Placenta previa is diagnosed through ultrasound, either during a routine prenatal appointment or after an episode of vaginal bleeding. Most cases of placenta previa are diagnosed during a second-trimester ultrasound exam.

• The initial diagnosis may be done with an ultrasound device on your abdomen. For more accurate images, it may also need a transvaginal ultrasound, which uses a wand like device placed inside your vagina. The provider will take care of the device’s position so as not to disrupt the placenta or cause bleeding

Importance of early detection and monitoring

Early detection and continuous monitoring of placenta previa are crucial for timely intervention and effective management. Identifying the condition early allows healthcare professionals to develop a comprehensive care plan, minimizing the risk of complications such as bleeding. Regular monitoring throughout the treatment strategy, ensuring the safety of both the mother and the baby. Overall, early detection and vigilant monitoring play a key role in optimizing outcomes for pregnancies affected by placenta previa.

Potential risks for the mother and baby

According to a study by Adere et. al in 2020, adverse maternal outcomes associated with placenta previa were postpartum anemia and the need for blood transfusion after significant amount blood loss due to the disease condition and its complications. Neonates born to women with placenta previa were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.

Potential risks for the mother:

•Bleeding - Severe possibly life-threatening vaginal bleeding (hemorrhage) that can occur during pregnancy, labor, delivery or in the first few hours after delivery.

•Placenta accreta spectrum - Placenta previa is associated with a group of conditions called placenta accreta spectrum. With these conditions, the placenta grows into or through the wall of the uterus. Placenta accreta has a high risk of bleeding during pregnancy or during and after delivery

Potential risks for the baby:

Preterm birth- Severe bleeding may prompt an emergency C-section before the baby is full term.

Long-term effects and considerations

•According to a study by Zhang et. al. In 2020, Women with a history of placenta previa are at risk for adverse outcomes such as postpartum hemorrhage, PAS disorders, and placenta previa in the subsequent pregnancy.

•Risk factors include advanced maternal age, multiple gestations, increased parity, past caesarean births, and past uterine curettage.

Research and Advancements

Current researches on placenta previa are focused on determining the effects of previous placenta previa on the maternal and neonatal outcomes of the next pregnancy. A 10-year study conducted in the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2009 and 2018, found that women with a history of placenta previa are at risk for adverse outcomes such as postpartum hemorrhage, placenta accreta spectrum disorders, and placenta previa in the subsequent pregnancy. The study also found that the risk of these adverse outcomes increased in women with a history of cesarean delivery.

Nursing Process Overview

An individualized nursing care plan is formulated in order to address the patient’s unique needs and health condition. An NCP for patients with placenta previa includes close monitoring of maternal vital signs, vaginal bleeding, and uterine activity. Generally, strict bed rest is often recommended to reduce the frequency of bleeding. Moreover, additional emotional support and education to the patient and family regarding the said condition should also be provided, including its signs of complication and when to seek medical assistance.

Assessment

The pregnant woman should be assessed for the following:

•Painless vaginal bleeding

•Fetal distress or decreased fetal movement

•Uterine tenderness

•Bright red blood in vaginal discharge

•Soft, relaxed uterus upon palpation

•Maternal symptoms of anemia: fatigue

•Abnormal fetal presentation

•Signs of shock

The aforementioned subjective and objective data to be gathered are necessary in serving as basis for the nursing care plan. Additionally, the assessment phase is a continuous process. Thus, it should be done every be functional.

Diagnosis

Following a thorough assessment, a nursing diagnosis that specifically address the related factors and challenges associated with placenta previa should be formulated. This diagnosis is based on the nurse’s clinical judgement and understanding on the patient’s individualized needs and unique health condition.

The following are example of possible nursing diagnoses for a woman having placenta previa:

•Risk for maternal injury related to placenta previa and potential hemorrhage.

•Risk for infection related to vaginal bleeding.

•Impaired gas exchange related to blood loss.

•Impaired tissue perfusion related to decreased blood flow.

•Risk for excessive bleeding related to placental location.

•Ineffective coping related to uncertainty about pregnancy outcome.

•Risk for altered parenting related to neonatal outcome.

Planning

During the planning phase, the nurse develops a plan of care with the cooperation and consent of the patient.

Any cultural or religious beliefs should be considered as these could potentially impact the care plan. Goals and expected outcomes for a pregnant woman with placenta previa may include:

•The client will manifest hemodynamic stability.

•The client will demonstrate behaviors to improve circulation.

•The client will display homeostasis as evidenced by the absence of bleeding.

•The client will demonstrate activities and participate in practices that reduce the workload of the heart.

•The client will be free from infections and any further complications.

•The client will independently comply to interventions to prevent or reduce the risk of infection, as well as adapt to lifestyle changes to prevent infection.

•The client will maintain fluid volume as evidenced by stable vital signs and adequate urinary output.

Implementation

The implementation phase is when the plan of care is getting carried out. The patient’s response should be closely monitored from time to time to recognize if there are any necessary adjustments to the care plan.

Nursing actions and interventions in caring for a woman with placenta previa may include:

•Preventing Hemorrhage by assessing color, odor, consistency, and amount of vaginal bleeding, by monitoring the client’s vital signs, by assessing hourly intake and output, assessing the abdomen for tenderness or rigidity. The FHR and uterine contractions should be monitored continuously. Perineal pads should be weighed to estimate blood loss. Vaginal examinations should be avoided as well.

•Promoting Effective Cardiac Function and Tissue. The client’s vital signs, and intake and output should be closely monitored. The client’s level pf consciousness should also be observed carefully. Providing a calm and quiet environment can avoid stimulation and helps the client relax and stay calm, which decreases the possibility of vasoconstriction and decrease myocardial workload. Assist and demonstrate client on how to do deep breathing exercises and encourage the use of stress management behaviors by using relaxation techniques.

•Preventing Infections. Assess the amniotic fluid drainage for color, clarity, and odor. Always ensure cleanliness and asepsis when caring for the patient. Instruct patient to do proper perineal care, if able.

Evaluation

Being the final step of the nursing process, it is during this stage where the nurse assesses the patient’s progress and determines whether or not the plan of care was effective.

The sought outcomes for a woman with placenta previa, given the proposed goals and interventions, include:

•Vital Signs Stability.

•Bleeding Assessment. The frequency of bleeding episodes should have reduced, as well as the amount of blood loss.

•Adherence to Bed Rest. The client should have understood the concept of bed rest and activity restrictions, as well as have adhered to these actions.

•Emotional Well-being. Along with the physical aspect, the emotional stability of the client should be ensured as well. The client should not possess any sign of anxiety, distress, or fatigue.

•Patient Education. The client’s level of understanding and perception should be assessed. The importance of other medical recommendations should also be evaluated.

Nursing Theories Jean Watson’s Theory of Human Caring

• Watson’s theory of human caring emphasizes the importance of the relationship of the nurse and the client and how caring is a fundamental component of nursing. It also encourages holistic care and understanding of the patient’s individual aspects of health. Dorothea Orem’s Self-Care Deficit Theory

• This theory focuses on the client’s ability to perform self-care as well as the nurse’s role as a companion in assisting clients in meeting their self-care needs. This is applicable in supporting the woman’s understanding of the presented concepts such as bed rest and activity restrictions. Betty Neuman’s Systems Model

• Neuman’s Systems Model views individuals as open systems that can potentially impact and take impact from the environment. This is relevant in maintaining the stability of the vital signs and bleeding episodes of a woman with placenta previa. This is because of the woman’s exposure to internal and external factors which can both affect the woman’s overall health.

Does having placenta previa in one pregnancy increase the likelihood of recurrence in subsequent pregnancies?

Yes, having placenta previa in one pregnancy does increase the likelihood of recurrence in subsequent pregnancies. The recurrence risk is approximately 5 in 100. Placenta previa is a condition where the placenta attaches to the lower uterine segment and partially or completely covers the internal cervix. It can lead to adverse outcomes such as postpartum hemorrhage, placenta accreta spectrum disorders, and recurrent placenta previa in subsequent pregnancies. If a woman has a history of placenta previa, it’s important for healthcare providers to closely monitor her during subsequent pregnancies to manage potential risks

Placenta Previa Overview:

•Placenta previa occurs when the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix.

•It can lead to severe bleeding during pregnancy, labor, or postpartum, posing risks for both the mother and the baby.

•Placenta previa is diagnosed through pregnancy ultrasound.

Management and Treatment:

•C-Section: Nearly all women with placenta previa require a cesarean section (C-section) for delivery. Vaginal delivery can cause severe bleeding if the placenta covers part or all of the cervix.

•Timing of Delivery: After 36 weeks, delivery of the baby is often recommended. The goal is to balance the risk of bleeding with the need for early delivery.

•Hospital Stay: The average hospital stay after a C-section is typically 2 to 4 days. However, it’s essential to note that recovery may take longer than after a vaginal birth.

•Recovery: Walking after the C-section is crucial to speed up recovery, and pain medication may be provided as needed.

Management and Treatment:

Additional Considerations:

•Continuous Monitoring: Some cases of placenta previa may require continuous fetal monitoring and bed rest in the hospital.

•Steroid Shots: Steroid shots may be given to help the baby’s lungs mature in case early delivery becomes necessary.

Remember that individual circumstances can vary, and healthcare providers tailor the management based on each patient’s specific needs. If you or someone you know is dealing with placenta previa, close medical supervision and timely interventions are crucial for a safe outcome

Placenta previa can indeed have implications for the baby’s health and development. Let’s explore these aspects:

• Preterm Birth Risk:

−Babies born to mothers with placenta previa are at an increased risk of preterm birth. Early delivery may be necessary to prevent severe bleeding during labor.

−Preterm babies may face challenges related to lung development, feeding, and temperature regulation.

• Intrauterine Growth Restriction (IUGR):

−Placenta previa can affect blood flow to the placenta, potentially leading to intrauterine growth restriction (IUGR).

−IUGR occurs when the baby does not grow adequately in the womb due to insufficient nutrients and oxygen.

• Neonatal Intensive Care Unit (NICU) Stay:

−Babies born to mothers with placenta previa may require admission to the NICU (Neonatal Intensive Care Unit) for monitoring and specialized care.

−NICU stays can vary in duration, depending on the baby’s overall health and any complications.

• Respiratory Distress Syndrome (RDS):

−Preterm babies are at risk of developing respiratory distress syndrome, which affects their ability to breathe.

−The immature lungs may struggle to produce enough surfactant, a substance that keeps the air sacs open.

Placenta previa can indeed have implications for the baby’s health and development. Let’s explore these aspects (continuation) :

• Anemia and Jaundice:

−In severe cases of placenta previa, the baby may experience anemia (low red blood cell count) due to blood loss during delivery.

−Anemia can lead to jaundice, characterized by yellowing of the skin and eyes.

• Long-Term Outcomes:

−While immediate complications can be managed, the long-term outcomes depend on the severity of placenta previa and any associated complications.

−Some babies may experience developmental delays or health issues related to prematurity.

• Close Monitoring and Follow-Up:

−Regular follow-up visits with pediatricians and developmental assessments are crucial for babies born to mothers with placenta previa.

−Early intervention services can address developmental delays if they arise.

Placenta previa is a condition where the placenta partially or completely covers the internal cervical os. Let’s delve into the impact of placenta previa on vascular changes within the placenta and its role in development:

Vascular Changes Associated with Placenta Previa:

•Placenta previa is often accompanied by abnormal placentation.

•Placental lesions, including maternal and fetal vascular supply lesions, are more common in placentas affected by previa.

•These vascular changes can disrupt the optimal blood flow between the mother and the fetus.

Negative Implications on Placental Function:

•The altered vascular morphology in placenta previa may have negative implications on placental function.

•Insufficient blood supply due to vascular abnormalities can affect nutrient and oxygen delivery to the developing fetus.

•This interference with placental function can impact fetal growth and development

Small-for-Gestational Age (SGA):

•Babies born to mothers with placenta previa have a higher rate of being small-for-gestational age (SGA).

•SGA infants may experience growth restriction due to inadequate nutrient supply through the placenta.

Placenta previa is a condition where the placenta partially or completely covers the internal cervical os. Let’s delve into the impact of placenta previa on vascular changes within the placenta and its role in development (continuation) :

Adverse Neonatal Outcome:

•Placenta previa is associated with a worse composite neonatal outcome.

•Neonates born to mothers with previa may face complications related to prematurity and impaired placental function.

Implantation Interference:

•The findings suggest that abnormal placentation in placenta previa interferes with fetal growth.

•Suboptimal implantation due to vascular changes may contribute to adverse outcomes.

In summary, placenta previa disrupts the normal vascular supply within the placenta, affecting nutrient exchange and fetal well-being. Close monitoring and timely interventions are crucial to mitigate risks during pregnancy.

Placenta previa is a condition where the placenta attaches lower in the uterus, resulting in some portion of the placental tissue covering the cervix. Let’s explore the microscopic structural changes that occur in the placenta with placenta previa and how they differ from a normal placenta:

Vascular Alterations:

•In placenta previa, the placental blood vessels may undergo changes due to abnormal placentation.

•The vascular architecture can be disrupted, affecting blood flow between the mother and the fetus.

•These alterations can impact nutrient exchange and oxygen delivery.

Decidual Changes:

•The decidua, which lines the uterine cavity during pregnancy, may exhibit differences.

•In placenta previa, the decidua near the cervix may be thinner or altered due to the placental position.

•This contrasts with a normal decidua, which supports optimal placental attachment.

Placental Location:

•In most pregnancies, the placenta is attached to the top or side of the uterus.

•With placenta previa, the placenta is lower in the uterus, potentially covering the cervix.

•This abnormal location affects the microscopic arrangement of placental villi and blood vessels.

Placenta previa is a condition where the placenta attaches lower in the uterus, resulting in some portion of the placental tissue covering the cervix. Let’s explore the microscopic structural changes that occur in the placenta with placenta previa and how they differ from a normal placenta (continuation):

Villous Morphology:

•The villi (finger-like projections) of the placenta may show variations.

•In placenta previa, villi near the cervix may be compressed or altered due to their proximity to the cervical os.

•Normal placentas have well-organized villous structures for efficient nutrient exchange.

Risk of Hemorrhage:

•The proximity of the placenta to the cervix in placenta previa increases the risk of bleeding.

•Microscopic disruptions in the placental barrier can lead to bleeding during pregnancy or delivery.

Role of Trophoblasts:

•Trophoblast cells play a crucial role in placental development.

•In placenta previa, abnormal trophoblast invasion may occur, affecting placental anchoring and function.

•Normal placentas have well-regulated trophoblast invasion for optimal nutrient transport

In summary, placenta previa involves alterations in vascular supply, villous morphology, and trophoblast behavior at the microscopic level. These changes impact both maternal and fetal well-being. Close monitoring and appropriate management are essential to mitigate risks associated with placenta previa

What is the main cause of bleeding?

• As the cervix begins to dilate during labor or contractions, the placental tissue covering the cervix is at risk of tearing or separating.

• When this happens, blood vessels within the placenta can rupture, leading to bleeding.

• The closer the placenta is to the cervix, the higher the risk of bleeding.

How is placenta previa treated?

There is no treatment to change the position of the placenta. You may need:

•More ultrasounds to track where the placenta is

•Bed rest or hospital stay

•Early delivery of the baby. This will be based on how much bleeding you have, how far along your baby is, and how healthy the baby is.

•Cesarean delivery

•Blood transfusion for severe blood loss

Fetal presentation and the occurrence of placenta previa:

Fetal Presentation:

•Fetal presentation refers to the part of the baby that is closest to the birth canal during pregnancy.

•The most common fetal presentations are cephalic (head-first) and breech (buttocks-first).

Placenta Previa and Fetal Presentation:

•There is no direct causal relationship between fetal presentation and the occurrence of placenta previa.

•However, some indirect factors may influence both conditions:

Factors to Consider:

•Multiparity: Women who have had multiple pregnancies (multiparity) are at higher risk for both placenta previa and abnormal fetal presentations.

•Uterine Abnormalities: Conditions such as fibroids or prior uterine surgery can affect both fetal positioning and placental implantation.

•Prior Cesarean Delivery: Women with a history of cesarean section are more likely to have placenta previa and may also experience abnormal fetal presentations.

Fetal presentation and the occurrence of placenta previa (continuation):

Clinical Implications:

•Placenta previa increases the risk of complications such as fetal malpresentation, preterm premature rupture of membranes, and fetal growth restriction.

•In women with prior cesarean deliveries, the risk of placenta accreta (abnormal placental attachment) is higher, especially with multiple prior cesarean deliveries.

Monitoring and Management:

•Healthcare providers closely monitor fetal presentation during pregnancy.

•If placenta previa is diagnosed, the mode of delivery (usually cesarean section) is determined based on both maternal and fetal factors.

In summary, while fetal presentation does not directly cause placenta previa, certain shared risk factors and clinical considerations warrant close attention during pregnancy.