Placenta previa

Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.

Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.

1. By: Sandhya Kashyap Nursing Tutor (OBG) Metro College of Health Sciences & Research Greater Noida , U.P. PLACENTA PREVIA

2. CONTENT Definition Pathophysiology Risk Factors Types Signs and Symptoms Diagnostic Tests Medical Management Surgical Management Nursing Management Nursing Assessment Nursing Diagnosis Nursing Care Plans Nursing Interventions Evaluation

3. Definition Placenta previa  is a condition wherein the placenta of a pregnant woman is implanted abnormally in the uterus. It accounts for the most incidents of bleeding in the third trimester of pregnancy.

4. Pathophysiology The placenta implants on the lower part of the uterus. The lower uterine segment separates from the upper segment as the cervix starts to dilate. The placenta is unable to stretch and accommodate the shape of the cervix, resulting in bleeding.

5. Risk Factors Placenta  previa is dangerous if not detected early. However, it is also highly preventable once you get to know the risk factors. Advanced maternal age . Women who are over the age of 35 years old are at an increased risk of developing placenta previa . Multiple gestations . The uterus which has accommodated more than one fetus has an increased risk for placenta previa . Increased parity . Women who have given birth to a lot of children have an increased chance of having placenta previa .

6. Past caesarean births . Giving birth via caesarean delivery predisposes the woman to placenta previa on her next childbearing. Past uterine curettage . Scars from a past curettage can affect the implantation of the uterus and lead to placenta previa

7. Types These types of placenta previa are classified according to the degree of the opening that is covered by the placenta.

8. Classification Previa is divided into four grades depending on the relationship and distance to the internal cervical os : grade I:  low-lying placenta: placenta lies in the lower uterine segment but its lower edge does not abut the internal cervical os ( i.e lower edge 0.5-2.0 cm from internal os ). grade II:  marginal previa : placental tissue reaches the margin of the internal cervical os , but does not cover it grade III : partial previa : placenta partially covers the internal cervical os grade IV:  complete previa : placenta completely covers the internal cervical os . Sometimes grades I and II are termed a "minor" or "partial" placenta previa , and grades III and IV are termed a "major" placenta previa .

9. Signs and Symptoms The following signs and symptoms for placenta previa must be detected immediately by the health care providers to avoid risking the life of the fetus . Bright red bleeding . When the placenta is unable to stretch to accommodate the shape of the cervix, bleeding will occur suddenly that could frighten the woman . Painless . Bleeding in placenta previa is not painless and may also stop as abruptly as it had begun.

10. Medical Management Medical interventions are necessary to ensure that the safety of both mother and fetus are still intact . Intravenous therapy . This would be prescribed by the physician to replace the blood that was lost during bleeding . Avoid vaginal examinations . This may initiate hemorrhage that is fatal for both the mother and the baby . Attach external monitoring equipment . To monitor the uterine contractions and record fetal heart sounds, an external equipment is preferred than the internal monitoring equipment.

11. Diagnostic Tests To diagnose placenta previa , the patient must undergo the following diagnostic procedure . Ultrasound . Early detection of placenta previa is always possible through ultrasonography . It is the most common and initial diagnostic test that could confirm the diagnosis.

12. Surgical  Management Surgical interventions are carried out once the condition of both the mother and the fetus has reached a critical stage and their lives are exposed to undeniable danger . Cesarean delivery.  Although the best way to deliver a baby is through normal delivery, if the placenta has obstructed more than 30% of the cervical os it would be hard for the fetus to get past the placenta through normal delivery. Cesarean birth is then recommended by the physician.

13. Nursing Management Nurses also play a major role in the care of a woman with placenta previa . They are also entrusted with the outcome of the lives of both the mother and the child.

14. Nursing Assessment Assess baseline vital signs especially the blood pressure. The physician would order monitoring of the blood pressure every 5-15 minutes. Assess fetal heart sounds to monitor the wellbeing of the fetus. Monitor uterine contractions to establish the progress of labor of the mother. Weigh perineal pads used during bleeding to calculate the amount of blood lost. Assist the woman in a side lying position when bleeding occurs.

15. Nursing Diagnosis Fear related to outcome of pregnancy due to bleeding

16. Nursing Interventions Assess fetal heart sounds so the mother would be aware of the health of her baby. Allow the mother to vent out her feelings to lessen her emotional stress. Assess any bleeding or spotting that might occur to give adequate measures. Answer the mother’s questions honestly to establish a trusting environment. Include the mother in the planning of the care plan for both the mother and the baby.

17. Evaluation Woman is able to discuss her concerns with the health care providers . States that hearing the fetal heartbeat assures her of the baby’s safety . One could move mountains just to save the lives of their mother and child. That is also true for health care providers. The conditions that affect the health of the mother and the baby can be conquered if both the support system and the health care providers are working as a team towards one measurable purpose: to save lives.

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