2021
A WRITTEN REPORT ON
Placenta Previa
PRESENTED BY: JO-AN PAULINE A. CASAS
PRESENTED TO: DR. MICHELLE C. TOLIBAS, RM, RN, MAN,
PHD
Placenta Previa
 A condition of pregnancy in which the placenta is implanted abnormally in the lower part
of the uterus, is the most common cause of painless bleeding in the third trimester of
pregnancy (Mastrolia, Baumfeld, Loverro, et al., 2016).
 Placenta previa is the most common cause of painless bleeding in the later stages of
pregnancy (after the 20th week). The placenta is a temporary organ that joins the mother
and fetus and transfers oxygen and nutrients from the mother to the fetus. The placenta
is disk-shaped and at full term measures about seven inches in diameter. The placenta
attaches to the wall of the uterus (womb). Placenta previa is a complication that results
from the placenta implanting either near to, or overlying, the outlet of the uterus (the
opening of the uterus, the cervix).
Because the placenta is rich in blood vessels, if it is implanted near the outlet of the uterus,
bleeding can occur when the cervix dilates or stretches (Stöppler, 2020).
Objectives
After this report, you will be able to acquire knowledge in depth regarding definition, etiology,
clinical features, diagnosis, complications, medical management of placenta Previa. Specifically,
you will be able to:
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Define placenta Previa and Explain the etiological factors of Placenta Previa.
Describe the types and classifications of Placenta Previa
Describe the clinical symptoms & diagnosis of Placenta Previa.
Describe the risk factors and predisposing factors that may lead to Placenta Previa
List down the complications, effects and dangers of Placenta Previa to the mother and
fetus
Describe the signs and symptoms that may manifest with the condition of Placenta Previa
Describe the management of Placenta Previa
List the therapeutic and nursing management that address the needs of a woman
experiencing a complication of Placenta Previa.
Formulate nursing care plan care specific to a woman who has developed a Placenta
Previa
Key Terms
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Amniotic fluid- the clear liquid that surrounds a developing fetus in the mother's womb
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Blastocyst- term for the conceptus at the developmental stage that consists of about 100
cells shaped into an inner cell mass that is fated to become the embryo and an outer
trophoblast that is fated to become the associated fetal membranes and placenta
Bradycardia- is a slower than normal heart rate. The hearts of adults at rest usually beat
between 60 and 100 times a minute.
Cervical Os- the internal opening of the cervix
Cesarean section- a surgical procedure involving incision of the walls of the abdomen
and uterus for delivery of offspring.
Contractions- tightening of the uterine muscles that help move the baby from the uterus
to and through the birth canal
Embryo- developing human during weeks
Fetus- developing human during the time from the end of the embryonic period (week 9)
to birth
Gestation- in human development, the period required for embryonic and fetal
development in utero; pregnancy
Human Chorionic Gonadotropin (hCG)- hormone that directs the corpus luteum to
survive, enlarge, and continue producing progesterone and estrogen to suppress menses
and secure an environment suitable for the developing embryo
Hemorrhage- a profuse discharge of blood, as from a ruptured blood vessel; bleeding.
Implantation- process by which a blastocyst embeds itself in the uterine endometrium
Labor- the process of childbirth, especially the period from the start of uterine contractions
to delivery.
Perineum- the area between the anus and the scrotum in the male and between the anus
and the vulva (the labial opening to the vagina)
Placenta- organ that forms during pregnancy to nourish the developing fetus; also
regulates waste and gas exchange between mother and fetus
Placenta Previa- low placement of fetus within uterus causes placenta to partially or
completely cover the opening of the cervix as it grows
Placentation- formation of the placenta; complete by weeks 14–16 of pregnancy
Postpartum- time after childbirth
Tachycardia- a heart rate that's too fast that the normal heart rate.
Trophoblast- fluid-filled shell of squamous cells destined to become the chorionic villi,
placenta, and associated fetal membranes
Uterus- Part of the female reproductive system. It is a muscular organ where the embryo
implants and grows during pregnancy.
Types/Classification
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Low Lying – The placenta implants in the lower uterine segment but does not reach
the cervical os; often this type of placenta previa moves upward as the pregnancy
progresses, eliminating bleeding complications later.
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Marginal– The edge of the placenta is at the edge of the internal os; the mother may
be able to deliver vaginally.
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Partial– The placenta partially covers the cervical os; as the pregnancy progresses
and the cervix begins to efface and dilate, the bleeding occurs.
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Total– The placenta covers the entire cervical os; usually requires an emergency
cesarean section.
Incidence
Placenta previa is found in approximately four out of every 1000 pregnancies beyond the 20th
week of gestation. Asian women are at a slightly greater risk for placenta previa than are women
of other ethnic groups, although the reason for this is unclear. It has also been observed that
women carrying male fetuses are at slightly greater risk for placenta previa than are women
carrying female fetuses.
The risk of having placenta previa increases with increasing maternal age and with the number
of previous deliveries. Women who have had placenta previa in one pregnancy also have a
greater risk for having placenta previa in subsequent pregnancies.
Causes
Low implantation of placenta possibly because of uterine abnormality
Researchers don't know what causes placenta previa. It is more likely to happen with certain
conditions. These include:
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Past pregnancies
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Tumors (fibroids) in the uterus. These are not cancer.
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Past uterine surgeries or cesarean deliveries
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Woman who is older than 35
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Woman who is African American or of another nonwhite ethnic background
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Cigarette smoking
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Placenta previa in a past pregnancy
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Being pregnant with a boy
Risk factors, predisposing factors
Placenta previa is more common among women who:
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Have had a baby
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Have scars on the uterus, such as from previous surgery, including cesarean deliveries,
uterine fibroid removal, and dilation and curettage
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Had placenta previa with a previous pregnancy
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Are carrying more than one fetus
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Are age 35 or older
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Are of a race other than white
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Smoke
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Use cocaine
Diagnosis: Laboratory, diagnostic examinations
General examination:
•The general condition of the patient depends upon the amount of blood loss.
•Shock develops if there is acute severe blood loss and anemia develops if there is recurrent
slight blood loss.
Abdominal examination:
• The uterus is corresponding to the GA, relaxed and not tender.
• The fetal parts and heart sound (FHS) can be easily detected.
• Malpresentation, particularly transverse and oblique lie and breech presentation are more
common as well as non-engagement of the head. This is because the lower uterine segment is
occupied by the placenta.
Ultrasound
• It is the simplest, precise and safe method for placental localization. A partially full bladder is
necessary to identify the lower edge of the placenta. If it is less than 3 cm from the margin of the
internal os, it is diagnosed as placenta Previa.
• The posterior placenta Previa is difficult to be identified due to shadowing from the presenting
part of the fetus. This can be overcome by head-down tilt of the patient or displacing, the
presenting part manually. If difficulty still present, the distance between the presenting part and
the promontory of the sacrum is measured. If this exceeds 1.5 cm it means that placenta lies in
between.
In mid - pregnancy the placenta reaches the internal os in up to 20% of pregnancies. With
increasing gestational age and the formation of the lower uterine segment, a gap develops
between the placental edge and the internal os "placental migration". So it is recommended to
repeat scan when placenta Previa is diagnosed in mid - pregnancy.
Don’t allow a vaginal examination to minimize placental trauma.
Vaginal examinations should not be done in the presence of fresh bleeding because fresh
bleeding may indicate that a placenta previa (implantation of the placenta so low in the uterus
that it is encroaching on the cervical os) is present. Performing a vaginal examination in this
instance might tear the placenta and cause hemorrhage, resulting in danger to both the mother
and fetus. Make certain a primary care provider knows about the fresh bleeding before
attempting a vaginal examination.
Prognosis
The majority of women with placenta previa in developed countries will deliver healthy babies,
and the maternal mortality (death) rate is less than 1%. In developing countries where medical
resources may be lacking, the risks for mother and fetus may be higher.
Complications/Effects/Danger (mother and fetus)
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Placenta previa can be associated with other abnormalities of the placenta or of the
umbilical cord. Some studies have shown a reduction in fetal growth associated with
placenta previa, and the presence of the placenta in the lower part of the uterus makes
breech or abnormal presentation of the fetus more likely.
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The bleeding of placenta previa can increase the risk for preterm premature rupture of the
membranes (PPROM), leading to premature labor.
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Placenta accreta is a serious complication that occurs in 5% to 10% of women with
placenta previa. Placenta accreta results when the placental tissue grows too deeply into
the womb, attaching to the muscle layer, resulting in difficulty separating the placenta from
the wall of the uterus at delivery. This complication can cause life-threatening bleeding
and commonly requires hysterectomy at the time of Cesarean delivery.
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As with other complications of pregnancy, placenta previa can have a significant emotional
impact on the pregnant woman.
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Vaginal bleeding secondary to placenta previa can lead to postpartum hemorrhage
requiring a blood transfusion, hysterectomy, maternal intensive care admission,
septicemia, and maternal death. Postpartum hemorrhage is blood loss greater than or
equal to 1000 ml accompanied by signs or symptoms of hypovolemia occurring within 24
hours after delivery, regardless of the route of delivery. This condition may necessitate
blood transfusion, uterotonics, uterine artery embolization, iliac artery ligation, balloon
tamponade, and hysterectomy. Placenta previa that is not diagnosed early enough or
managed improperly can lead to morbidity and mortality for both the mother and fetus.
Placenta previa is also associated with preterm birth, low birth weight, lower APGAR
scores, longer duration of hospitalization, and higher blood transfusion rates.[1] Women
with placenta previa and prior history of cesarean sections are at an increased risk of PAS.
Risk of placenta accreta is 3%, 11%, 40%, 61%, and 67%, for the first, second, third,
fourth, and fifth or more cesarean, respective
Assessment (signs and symptoms)
 The bleeding with Placenta Previa doesn’t usually begin, however, until the lower uterine
segment starts to differentiate from the upper segment late in pregnancy (approximately
week 30) and the cervix begins to dilate. At that point, because the placenta is unable to
stretch to accommodate the differing shape of the lower uterine segment or the cervix, a
small portion loosens and damaged blood vessels begin to bleed. The bleeding is usually
abrupt, painless, bright red, and sudden enough to frighten a woman. It is not associated
with increased activity or participation in sports and may stop as abruptly as it began, so
that by the time a woman is seen at the healthcare setting, she is no longer bleeding. In
other women, it may slow after the initial hemorrhage but linger as continuous spotting.
(Faan & Pnp, 2017, pp. 538).
 According to Gaiman (2019), bleeding is the primary symptom of placenta previa and
occurs in the majority (70%-80%) of women with this condition.
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Vaginal bleeding after the 20th week of gestation is characteristic of placenta previa. The
placenta in this stage is well developed or matured and needed more blood supply, so it
migrates to a more vascularized part of the uterus.
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Bleeding, bright red in color is associated with the stretching and thinning of the lower
uterine segment that occurs during the third trimester.
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Usually the bleeding is painless, but it can be associated with uterine contractions
and abdominal pain. The uterus is not able to adequately contract and stop blood flow
from open vessels.
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Bleeding may range in severity from light to severe.
Nursing diagnosis
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Fear related to outcome of pregnancy after episode of placenta previa bleeding
Fear related to Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss
Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental
Implantation
Decreased cardiac output r/t altered contractility
Ineffective tissue perfusion r/t decreased HgB concentration in blood & hypovolemia
Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation
Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation
Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to Potential for
Hemorrhage
Altered Diversional Activity r/t Inability to Engage in Usual Activities Secondary to Enforced
Bed Rest and Inactivity During Pregnancy
Discussion
Age is a risk factor. Age is associated with a varying incidence of Placenta Previa. The risk of Placenta Previa is increased
with increasing maternal age. Placenta Previa in turn increases the risk of complications like obstetrical hemorrhage and the need for
caesarean hysterectomy. Placenta Previa is associated with male births. The reason for this is not known but it could be linked to
maternal hormones or prematurity. Premature rupture of membranes occurs more commonly in pregnant women with male babies
and Placenta Previa is also more common in premature pregnancies. (Kiondo et al., 2008)
The contributing factors for Placenta Previa is a previous delivery by caesarean section. The risk increases with the number
of caesarean sections performed. The incidence is 2% after one previous caesarean section, 4.1% after two and 22% after three.
Similarly, dilation and curettage, evacuation of uterus and myomectomy are associated with Placenta Previa and is more common in
older and multiparous women; the reason is not clear but it may be associated with the ageing of vasculature of the uterus. This
causes placental hypertrophy and enlargement which increases the likelihood of the placenta encroaching on lower segment.
Birth spacing is also associated with a risk of Placenta Previa. In a study carried out among Norwegian women, it was found that
birth spacing of more than four years was associated with Placenta Previa, this could be due to scarring or poor vasculature of the
uterus which is associated with increasing age. Mothers with Placenta Previa have a ten-fold risk of reoccurrence in a subsequent
pregnancy. This is thought to be linked to defective decidual vascularisation. Moreover, abnormal placentation and smoking have
been attributed to abruptio placenta and Placenta Previa. Smoking seems to increase the risk of previa via a hypoxemia-related
mechanism. Nicotine has a vasoconstricting effect on uteroplacental perfusion in smoking mothers. Placental studies have
demonstrated decreased vascularization and pronounced changes in the broad basement membrane of mothers who smoked
cigarettes. Multiple pregnancies are also associated with Placenta Previa, this is because the large placenta usually encroaches on
lower segment of the uterus (Kiondo et al., 2008).
The underlying cause of placenta previa is unknown. There is, however, an association between endometrial damage and
uterine scarring. The implantation of a zygote (fertilized egg) requires an environment rich in oxygen and collagen. The outer layer of
the dividing zygote, blastocyst, is made up of trophoblast cells which develops into the placenta and fetal membranes. The
trophoblast adheres to the decidua basalis of the endometrium, forming a normal pregnancy. Prior uterine scars provide an
environment that is rich in oxygen and collagen. The trophoblast can adhere to the uterine scar leading to the placenta covering the
cervical os or the placenta invading the walls of the myometrium. There normally exists an apparent placental migration, with one
edge of the placenta growing while the opposite edge atrophies. It has been noted that the placenta initially will occupy from one half
to one third of the uterine wall. By term, however, no more than one fourth to one sixth of the uterine surface is covered. This change
in ratio permits a degree of apparent placental movement. In placenta previa, it is postulated that there is an impairment of this
normal placental progression away from the cervical os. It is believed that this migration is impaired in women with surgically scarred
uteri, which is why they are at greater risk for placenta previa.
It occurs in four degrees: implantation in the lower rather than in the upper portion of the uterus (low-lying placenta), marginal
implantation (the placenta edge approaches that of the cervical os), implantation that occludes a portion of the cervical os (partial
Placenta Previa), and implantation that totally obstructs the cervical os (total Placenta Previa). The degree to which the placenta
covers the internal cervical os is generally estimated in percentages: 100%, 75%, 30%, and so forth (Faan & Pnp, 2017, pp. 538).
Towards the end of the pregnancy, the wall of the uterus at the cervix thins out to widen the passage for the baby. Normally
this is a good thing, but in placenta previa, it can be a pretty dangerous thing. When wall of the uterus thins out, the attachment
between the uterus and the placenta is actually strained. It starts to become weakened and the placenta starts to detach. The uterine
arteries which are in the wall of the uterus are being tugged on in one direction as the wall thins out, but since they're also attached to
the placenta, they're also being tugged on in the opposite direction. The tension on these arteries can cause them to rupture and
blood leaks through into the vagina.
Bleeding is the primary symptom of Placenta Previa and occurs in the majority (70%-80%) of women with this condition.
Vaginal bleeding after the 20th week of gestation is characteristic of Placenta Previa. The placenta in this stage is well developed
or matured and needed more blood supply, so it migrates to a more vascularized part of the uterus.
Bleeding, bright red in color is associated with the stretching and thinning of the lower uterine segment that occurs during the third
trimester. Usually the bleeding is painless, but it can be associated with uterine contractions and abdominal pain. The uterus is not
able to adequately contract and stop blood flow from open vessels. (Gaiman, 2019)
The most common cause of fetal distress is when the baby doesn't receive enough oxygen because of problems with the
placenta (including placental abruption or placental insufficiency)
Placental insufficiency occurs when the placenta does not develop properly, or is damaged. This blood flow disorder is marked by a
reduction in the mother’s blood supply. The complication can also occur when the mother’s blood supply doesn’t adequately increase
by mid-pregnancy. When the placenta malfunctions, it’s unable to supply adequate oxygen and nutrients to the baby from the
mother’s bloodstream. Without this vital support, the baby cannot grow and thrive. This can lead to low birth weight, premature birth,
and birth defects. Low birth weight is defined as a birth weight of an infant less than 2500 grams at full term. It can result from
intrauterine growth restriction and/or preterm birth. IUGR is often a comorbidity of preterm birth and it is linked with induction of
assisted and non-assisted premature delivery. Moreover, excessive maternal hemorrhage can cause a severe drop in blood
pressure. It may lead to shock and death if not treated.
Pathophysiologic events/pathophysiology (Discussion and Schematic diagram)
Risk Factors
• Woman who is older than 35
• Woman who is African
American or of another
nonwhite ethnic background
Cause
The underlying cause of
Placenta Previa is unknown.
There is, however, an
association between endometrial
damage and uterine scarring.
Contributing factors
• Have scars on the uterus, such
as from previous surgery,
including cesarean deliveries,
uterine fibroid removal, and
dilation and curettage
• Genetics
• Being pregnant with a boy
• Are of a race other than
white
• Are carrying more than one
fetus
• Past pregnancies
• Birth spacing
• Had placenta previa with a
previous pregnancy
• Smoke
• Use cocaine
Prior uterine scars provide an environment
that is rich in oxygen and collagen
Placenta migrates to where there is
sufficient blood supply
An impairment in the normal placental
progression away from the cervical os.
Placenta resides in the lower uterine
segment
Total Placenta Previa
THE PLACENTA COVERS
THE ENTIRE CERVICAL OS
Partial Placenta Previa
Marginal Placenta Previa
THE PLACENTA PARTIALLY
COVERS THE CERVICAL OS
THE EDGE OF THE
PLACENTA IS AT THE EDGE
OF THE INTERNAL OS
Low-lying Placenta Previa
THE PLACENTA IMPLANTS
IN THE LOWER UTERINE
SEGMENT BUT DOES NOT
REACH THE CERVICAL OS
When the stretching and thinning of the lower
uterine segment occurs in third trimester, the
attachment between the uterus and the placenta is
strained and the placenta starts to detach
As the wall thins out, the uterine arteries in
the wall of the uterus are being tugged on
in one direction, since they're also attached
to the placenta, they're also being tugged
on in the opposite direction.
Tension on these arteries can cause them
to rupture
Bright Red Painless Vaginal Bleeding
Excessive maternal
hemorrhage
Low maternal blood flow
Placental insufficiency
Intrauterine Growth
Retardation
Severe drop in blood
pressure
Lack of oxygen
Shock
Fetal distress
Death
Preterm birth
Birth defects
Low birth weight
Therapeutic Management
For a first (sentinel) episode of vaginal bleeding before 36 weeks, management consists of:
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Hospitalization
Modified activity (modified rest)- involves refraining from any activity that increases intraabdominal pressure for a long period of time—eg, women should stay off their feet most
of the day.)
Avoidance of sexual intercourse, which can cause bleeding by initiating contractions or
causing direct trauma.
If bleeding stops, ambulation and usually hospital discharge are allowed.
Typically for a 2nd bleeding episode, patients are readmitted and may be kept for observation
until delivery.
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Some experts recommend giving corticosteroids to accelerate fetal lung maturity when
early delivery may become necessary and gestational age is < 34 weeks. Corticosteroids
may be used if bleeding occurs after 34 weeks and before 36 weeks (late preterm period)
in patients who have not required corticosteroids before 34 weeks (1).
Timing of delivery depends on the maternal and/or fetal condition. If the patient is stable,
delivery can be done at 36 weeks/0 days to 37 weeks/6 days. Documentation of lung
maturity is no longer necessary.
Delivery is indicated for any of the following:
- Heavy or uncontrolled bleeding
- Nonreasoning results of fetal heart monitoring
- Maternal hemodynamic instability
Delivery is cesarean for placenta previa. Vaginal delivery may be possible for women with
a low-lying placenta if the placental edge is within 1.5 to 2.0 cm of the cervical os and the
clinician is comfortable with this method.
Hemorrhagic shock is treated. Prophylactic Rho(D) immune globulin should be given if the
mother has Rh-negative blood.
Nursing Management
 Inspect the perineum for bleeding and estimate the present rate of blood loss. Weighing
perineal pads before and after use and calculating the difference by subtraction is a good
method to determine vaginal blood loss. An Apt or Kleihauer– Betke test (test strip
procedures) can be used to detect whether the blood is of fetal or maternal origin.
 Obtain baseline vital signs to determine whether symptoms of hypovolemic shock are
present.
 Continue to assess blood pressure every 5 to 15 minutes or continuously with an electronic
cuff. Never attempt a pelvic or rectal examination with painless bleeding late in pregnancy
because any agitation of the cervix when there is a placenta previa might tear the placenta
further and initiate massive hemorrhage, possibly fatal to both mother and child.
 Attach external monitoring equipment to record fetal heart sounds and uterine contractions
(an internal monitor for either fetal or uterine assessment is contraindicated).
 Hemoglobin, hematocrit, prothrombin time, partial thromboplastin time, fibrinogen, platelet
count, type and cross-match, and antibody screen will be assessed to establish baselines,
detect a possible clotting disorder, and ready blood for replacement if necessary.
 Monitor urine output frequently, as often as every hour, as an indicator her blood volume
is remaining adequate to perfuse her kidneys.
 Administer intravenous fluid as prescribed, preferably with a large-gauge catheter to allow
for blood replacement through the same line.
 A vaginal birth is always safest for an infant. It is essential, therefore, to determine the
placenta’s location as accurately as possible in the hope that its position will make vaginal
birth feasible.
 If the previa is under 30% by abdominal or intravaginal ultrasound, it may be possible for
the fetus to be born past it. If over 30%, and the fetus is mature, the safest birth method
for both mother and baby is often a cesarean birth (Kim, Joung, Lee, et al., 2015).
 If only a minimum previa is detected by sonogram, the primary healthcare provider may
attempt a careful speculum examination of the vagina and cervix to establish the degree
of fetal engagement and to rule out another cause for bleeding, such as ruptured varices
or cervical trauma.
This should be done in an operating room or a fully equipped birthing room so that if
hemorrhage does occur with cervical manipulation, an immediate cesarean birth can be
carried out to remove the child and the bleeding placenta and contract the uterus.
Have oxygen equipment available in case the fetal heart sounds indicate fetal distress,
such as bradycardia or tachycardia, late deceleration, or variable decelerations during the
exam.
NCP
Care Plan No.: ___1___
Patient’s Name: _____P.T.
Assessment Cues
Age/Sex: _36/Female_______ Chief Complaint/s: Severe bleeding
Nursing Diagnosis
Subjective:
“Dinudugo ako at
tila marami nang
lumalabas na dugo
sa akin!” (I’m
bleeding and it
seems like there’s
a lot of blood
coming out from
me) as verbalized
by the patient.
Objective:
-Bleeding episodes
-Manifest body
weakness
-Low BP of 90/50
mm Hg
-Increased HR of
100 beats per
minute
Outcome
Identification
Goal:
Fluid volume
Deficient r/t Active
Blood Blood Loss
Secondary to
Disrupted Placental
Implantation
Scientific Basis:
Fluid volume
deficient is a state in
which an individual
is experiencing
decreased
intravascular,
interstitial and/or
intracellular fluid.
Active Blood Loss or
hemorrhage due to
disrupted placental
implantation during
pregnancy may
manifest signs and
symptoms of fluid
volume deficient that
After rendering
nursing
intervention and
medical
assistance,
patient will exhibit
signs of adequate
fluid balance
during pregnancy
Planned Nursing Interventions
Nursing
Rationale
Interventions
Independent:
-Assess color, odor,
consistency and
amount of vaginal
bleeding; weigh
pads
-Assess hourly
intake and output
Desired
Outcome:
The patient will be
able to:
-Maintain fluid
volume at a
functional level as
evidenced by
individually
adequate urinary
output with
-Assess baseline
data and note
changes. Monitor
FHR
-Provides
information about
active bleeding
versus old blood,
tissue loss and
degree of blood loss
-Provides
information about
maternal and fetal
physiologic
compensation to
blood loss
-Assessment
provides information
about possible
infection, placenta
previa or abruption.
Warm, moist,
bloody environment
is ideal for growth of
microorganisms.
Evaluation
Goal met.
After rendering
nursing
intervention and
medical
assistance, the
patient has exhibit
signs of adequate
fluid balance.
The patient has
maintained fluid
volume at a
functional level as
evidenced by
individually
adequate urinary
output with normal
specific gravity,
stable vital signs,
moist mucous
membranes, good
Skin turgor, prompt
capillary refill.
-Decreased RR of
12 breaths per
minute
may later lead to
hypovolemic shock
and cause maternal
and fetal death.
-Fetal heart rate
>120-160 bpm
Reference:
-Decreased urine
output
-Increased urine
concentration
-Pale, cool skin
Vera, M. B. (2019b,
June 1). 3 Placenta
Previa Nursing Care
Plans. Nurseslabs.
https://nurseslabs.
com/3- placentaprevia-nursing-careplans /#decreased
_cardiac_output
normal specific
gravity, stable
vital signs, moist
mucous
membranes, good
Skin turgor,
prompt capillary
refill.
-Assess abdomen
for tenderness or
rigidity-if present,
measure abdomen
at umbilicus (specify
time interval)
-Detecting
increased in
measurement of
abdominal girth
suggest active
abruption
-Assess SaO2, skin
color, temperature,
moisture, turgor,
capillary refill
(specify frequency)
-Assessment
provides information
about blood volume,
O2 saturation and
peripheral perfusion
-Assess for changes
in LOC: note for
complaints of thirst
or apprehension
-To detect signs of
cerebral perfusion
-Monitor laboratory
work as obtained:
Hgb & Hct, Rh and
type, cross match for
2 units RBC’s,
urinalysis, etc.
Scheduled for
ultrasound as
ordered.
-Laboratory work
provides information
about degree of
blood loss; prepares
for possible
transfusion.
Ultrasound provides
info about the cause
of bleeding.
-Provide emotional
support; keep patient
and family informed
of findings and
continuing plan of
care.
-Support and
information
decreases anxiety
and help patient
and family to
anticipate what
might happen next.
Dependent:
-Provide
supplemental O2 as
ordered via
facemask or nasal
cannula @ 10-12
L/min.
-Intervention
increases available
O2 to saturate
decreased
hemoglobin
-Initiate IV fluids as
ordered (specify fluid
type and rate).
-For replacement of
fluid volume loss
-Position patient in
supine with hips
elevated if ordered
or left lateral
position.
-Position decreases
pressure on
placenta and
cervical os. Left
lateral position
improves placental
perfusion.
-Determine if patient
has any objections
to blood
transfusions—inform
physician.
-Administer blood
transfusion as
ordered with client
consent
-Monitor closely for
transfusions reaction
Patient may have
religious beliefs
related to accepting
blood products.
-To provide
replacement of
blood components
and volume
-To prevent for
potentially lifethreatening allergic
reaction that may
result from
incompatible blood
Collaborative:
-Administer prenatal
vitamins and iron as
ordered: provide a
diet high in iron; lean
meats, dark green
leafy vegetables,
eggs, and whole
grains.
Prepare patient for
cesarean birth if
ordered when
severe hemorrhage,
abruption, complete
previa at term is
already experienced.
-Proper diet and
vitamins replace
nutrient lost from
active bleeding to
prevent anemiairon is a necessary
component of
hemoglobin
-Cesarean birth
may be necessary
to resolve the
hemorrhage or
prevent fetal or
maternal injury.
Care Plan No.: ___2___
Patient’s Name: _____P.T.
Assessment Cues
Age/Sex: _36/Female_______ Chief Complaint/s: Difficulty breathing and nausea
Nursing Diagnosis
Subjective:
“Maglisod kog
ginhawa unya
malipong sad” as
verbalized by the
patienyt
Objective:
-Dysrhythmias
-Prolonged
capillary refill
-Cold clammy skin
Goal:
Nursing Diagnosis:
Decreased cardiac
output related to
altered cardiac
contractility
secondary to
placenta previa, as
evidenced by
cardiac
dysrhythmias, cold
and clammy skin,
shortness of breath,
variations in blood
pressure readings,
and restlessness
-Dyspnea
Scientific Basis:
-Restlessness
-Variations in BP
reading
Outcome
Identification
Placenta previa is
the development of
placenta in the lower
uterine segment
partially or
completely covering
the internal cervical
os. Placenta Previa
After 4 hrs of
Nursing
Intervention, the
patient will
participate and
demonstrate
activities that
reduce the
workload of the
heart.
Desired
Outcome:
Patient will
manifest
hemodynamic
stability.
Planned Nursing Interventions
Nursing
Rationale
Interventions
Independent:
-Establish Rapport
-To gain patient’s
trust
-Monitor Vital Signs
-To obtain baseline
data
-History taking
-To determine
contributing factors
-Assess patient
condition
-To assess
contributing factors
-Review lab data
-For comparison
with current normal
values
-Monitor BP & Pulse
frequently
-To note response
to activity
-Provide information
on test procedures
-To gain patient’s
participation
-Provide adequate
rest & Reposition
client
-To promote
venous return
Evaluation
Goal met.
After 4 hrs of
Nursing
Intervention, the
patient was able to
participate and
demonstrate
activities that
reduce the
workload of the
heart. The patient
has manifested
hemodynamic
stability.
causes bleeding.
Due to large
amounts of blood
lost, the heart tries
to pump faster in
order to compensate
for blood loss. As a
result, the heart
pumps faster with
lesser blood
pumped.
Reference:
Vera, M. B. (2019b,
June 1). 3 Placenta
Previa Nursing Care
Plans. Nurseslabs.
https://nurseslabs.
com/3- placentaprevia-nursing-careplans /#decreased
_cardiac_output
-Encourage
relaxation
techniques
-To alleviate stress
& anxiety
Care Plan No.: ___3___
Patient’s Name: _____P.T.
Assessment
Cues
Age/Sex: _36/Female_______ Chief Complaint/s: Nausea and body weakness
Nursing Diagnosis
Subjective:
“Usahay malipong
unya maluya
akong lawas” as
verbalized by the
patient.
Goal:
Ineffective tissue
perfusion r/t
decreased HgB
concentration in
blood &
hypovolemia
Objective:
Restlessness
Confusion
Irritability
Manifest Body
Weakness
Capillary refill more
than 3 sec
Oliguria
Outcome
Identification
Planned Nursing Interventions
Nursing
Rationale
Interventions
Independent:
Patient will
demonstrate
behaviors to
improve
circulation.
-Establish Rapport
-To gain patient’s
trust
-Monitor Vital Signs
-To obtain
baseline data
Desired
Outcome:
-Assess patient
condition
-To assess
contributing
factors
Scientific Basis:
Placenta Previa
causes painless and
continuous bleeding.
With bleeding, there
is decreased
Hemoglobin.
Hemoglobin carries
oxygen to different
parts of the body. If
there is decreased
hemoglobin there is
a failure to nourish
the tissues at the
capillary level.
Reference:
Patient will
demonstrate
increased
perfusion as
individually
appropriate. (e.g.
hematocrit,
hemoglobin,
RBC,WBC,
capillary refill, BP
within normal
range, absence of
edema).
-Note customary
baseline data (usual
BP, weight, lab
values)
-Determine
presence of
dysrhythmias
-Perform blanch test
-Check for Homan’s
Sign
-For comparison
with current
findings
-To identify
alterations from
normal
-To identify and
determine
adequate
perfusion
Evaluation
Goal partially met.
.After 2 days of
nursing intervention,
the client was able to
demonstrate light
increased perfusion
as evidenced by
increased in
hemoglobin
(79.0g/L),hematocrit
(.22),RBC(2.28
10^12/L)and WBC
(2.9010^9/L) but still
with the presence of
pallor, edema,
delayed capillary
refill.
Vera, M. B. (2019b,
June 1). 3 Placenta
Previa Nursing Care
Plans. Nurseslabs.
https://nurseslabs.
com/3- placentaprevia-nursing-careplans /#decreased
_cardiac_output
-To determine
presence of
thrombus
formation
-Encourage quiet &
restful environment
-Elevate HOB
-Encourage use of
relaxation
techniques
-To lessen O2
demand
-To promote
circulation
-To decrease
tension level
References
Anderson-Bagga, F. M. (2020, June 27). Placenta Previa - StatPearls - NCBI Bookshelf. National
Center
for
Biotechnology Information,
U.S.
National
Library of
Medicine.
https://www.ncbi.nlm.nih.gov/books/NBK539818/
Betts, G. J. (2013, March 6). Embryonic Development – Anatomy and Physiology. Pressbooks.
https://opentextbc.ca/anatomyandphysiologyopenstax/chapter/embryonic-development/
Faan, S. J. D. C. I., & Pnp, P. A. P. R. (2017). Maternal and Child Health Nursing: Care of the
Childbearing and Childrearing Family (8th ed., Vol. 1). LWW.
Gaiman,
N.
(2019,
October
9).
CP
Placenta
Previa.
Scribd.
https://www.scribd.com/doc/20845207/CP-Placenta-Previa
Kiondo, P., Wandabwa, J., & Doyle, P. (2008, March 1). Risk factors for placenta praevia
presenting with severe vaginal bleeding in Mulago hospital, Kampala, Uganda. PubMed
Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408550/
Mayo Foundation for Medical Education and Research. (2020, May 30). Placenta previa Symptoms
and
causes.
Mayo
Clinic.
https://www.mayoclinic.org/diseases-
conditions/placenta-previa/symptoms-causes/syc-20352768
R. (2020, August 21). Placenta Previa Nursing Management. Nursing Journal | RNspeak.
https://rnspeak.com/placenta-previa-nursing-management/
Stöppler, M. C. (2020, January 7). Placenta Previa Symptoms, 3 Types, Causes, Risks, Treatment.
MedicineNet. https://www.medicinenet.com/pregnancy_placenta_previa/article.htm
Vera, M. B. (2019, June 1). 3 Placenta Previa Nursing Care Plans. Nurseslabs.
https://nurseslabs.com/3-placenta-previa-nursing-care-plans/