Placenta Previa

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

• 1) complete or total: when the cervical os is completely covered by the placental attachment
• 2) incomplete or partial: when the cervical os is only partially covered by the placental attachment
• 3) Marginal or low-lying: when the placenta is attached in the lower uterine segment but does not reach the cervical os

• previous placenta previa
• Uterine scarring (previous cesarean birth, curettage, endometritis)
• Maternal age greater than 35 years
• Multifetal gestation
• Multiple gestations or closely spaced pregnancies

• Subjective data:
• Painless, bright red vaginal bleeding that increases as the cervix dilates

• Objective data:
• A soft relaxed nontender uterus with normal tone
• a fundal height that is greater than usually expected for gestational age
• a fetus in a breach, oblique, or transverse position
• a palpable placenta
• vital signs that are usual and within normal limits
• a decreasing urinary output

• Laboratory test:
• Hgb and Hct for blood loss
• ABO blood typing and Rh factor
• Coagulation profile
• Kleihauer-Betke test (used to detect fetal blood in maternal circulation)

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

• Nursing Care:
• assess the patient for bleeding, leakage, or contractions
• assess fundal height
• perform leopold maneuvers (fetal position and presentation)
• refrain from performing vaginal exams (may exacerbate bleeding)
• administer IV fluids to the patient as prescribed
• have oxygen equipment available in case of fetal distress

Medications: Corticosteroids such as betamethasone (Celestone) are prescribed for fetal lung maturation if delivery of the fetus is anticipated (cesarean birth)

• Discharge instructions:
• bed rest
• nothing inserted vaginally
• blood replacement as prescribed

• expected outcome:
• pregnancy will be maintained without any maternal or fetal compromise