Placenta Previa Nursing Care Plan and Management

Placenta previa is the placenta implanting low and partially or fully covering the cervical os. The danger is bleeding, classically bright red and sudden, most often in the third trimester. It demands close monitoring, prompt ultrasound, and a hard rule you never break: no vaginal exams. Manage it well and both mother and baby come through safely.

What is Placenta Previa?

The placenta partially or completely covers the cervical opening, blocking the normal route for delivery and causing vaginal bleeding, especially in the third trimester.

Pathophysiology

The placenta implants on the lower uterus. As the cervix dilates, the lower uterine segment separates from the upper segment. The placenta cannot stretch to follow the cervix, and it bleeds.

Risk Factors

• Advanced maternal age. Risk rises in women over 35.
• Multiple gestations. A uterus that has carried more than one fetus is at higher risk.
• Increased parity. More prior births, higher risk.
• Past cesarean births. Prior cesarean predisposes to previa in the next pregnancy.
• Past uterine curettage. Scarring affects implantation.

Types

Classified by how much of the os the placenta covers:

• Low-lying placenta. Implants in the lower uterus rather than the upper.
• Marginal implantation. The placenta's edge nears the cervical os.
• Partial placenta previa. Part of the os is covered.
• Total placenta previa. The placenta occludes the entire os.

Signs and Symptoms

• Bright red bleeding. When the placenta cannot stretch to follow the cervix, bleeding starts suddenly and can frighten the patient.
• Painless. Bleeding in placenta previa is classically painless and may stop as abruptly as it began.

Diagnostic Tests

• Ultrasound. The first and most common test, and it detects previa early.

Medical Management

• IV therapy. Replaces blood lost during bleeding.
• No vaginal examinations. They can trigger fatal hemorrhage.
• External monitoring. Use external equipment for uterine contractions and fetal heart sounds, not internal.

Surgical Management

• Cesarean delivery. If the placenta obstructs more than 30% of the cervical os, vaginal delivery is not feasible and cesarean is recommended.

Nursing Management

Nursing Assessment

• Assess baseline vital signs, especially blood pressure. The physician may order blood pressure every 5 to 15 minutes.
• Assess fetal heart sounds.
• Monitor uterine contractions to track labor progress.
• Weigh perineal pads used during bleeding to estimate blood loss.
• Position her side-lying when bleeding occurs.

Nursing Diagnosis

• Fear related to the outcome of pregnancy due to bleeding.

Nursing Interventions

• Assess fetal heart sounds and share them so she knows her baby's status.
• Let her vent to ease emotional stress.
• Assess any bleeding or spotting and act on it.
• Answer her questions honestly to build trust.
• Include her in planning the care plan for her and the baby.

Evaluation

• She discusses her concerns with the team.
• She states that hearing the fetal heartbeat reassures her of the baby's safety.

Protecting two patients at once is the work here. With a steady team and a supported mother, these pregnancies can be brought through safely.