Placenta Previa in Pregnancy
Case study
Presented to the
College of Nursing
In partial fullfilment of the requirements
in
NCM 109 RLE
Care of mother and Child at Risk or with Problems
OBW
Submitted to:
Sonia Adefuin Delantar, RN, MAN,LPT
Submitted by:
Gleisy G. Saguno
BSN 2
1
Table of Contents
Title page………………………………….………………………………..………….………..1
Tale of Contents…………………………………………………………………………………2
Foreword……………………………………………………………...…………………….…...3
Dedication…………………………………………...…………………………………………..3
Objectives………………………………………………………………………………………..3
Introduction……………………………………………………………………………………...4
Patients Data…………………………………………………………………………………….6
Physical Assessment…………………………………………………………………………….7
Laboratory Result/Diagnostic Result……………………………………………………………9
Anatomy and Physiology……………………………………………………………………….12
Pathophysiology………………………………………………………………………………...13
Medical Management…………………………………………………………………………...14
Nursing Care Plan………………………………………………………………………………17
FDAR…….……………………………………………………………………………………..21
Drug Study……………………………………………………………………………………..22
Discharge Plan…………………………………………………………………………………27
Prognosis………………………………………………………………………………………28
Reference………………………………………………………………………………………29
2
I. Foreword
Placenta previa is a severe complication of pregnancy and is the most common cause of
postpartum hemorrhage, which often endangers the lives of pregnant women. In recent years, an
increasing number of researchers believe that the placenta previa position has an important
influence on the pregnancy outcome. In 80% cases it is found in multiparous women. The
incidence increase beyond the age of 35, with high birth order pregnancies and in multiple
pregnancy. The incidences approximately 4-5 per thousand pregnancies.
During the course of clinical treatment of placenta previa, nursing student should be aware of not
only the types of placenta previa (complete and partial or marginal placenta previa) but also the
position of placental attachment (e.g., anterior uterine wall, posterior wall, whether the placenta
overlaps a surgical scar from a previous caesarean section). Some researchers have suggested
that complete placenta previa, which is characterized by placental attachment to the anterior wall
covering the uterine scar, should be defined as pernicious placenta previa. Placenta previa is a
medical emergency that needs immediate management because it can lead to serious maternal
and fetal complication, even death of one or both of them. Once diagnosed, close observation
must be done to monitor the status of both the mother and the baby. Any untoward attending
physcian. Complications can be diminished if the diagnosis and management are done at an early
stage.
II. Dedication
This Case study is wholeheartedly dedicated to my beloved parents, who have been my source of
inspiration and gave me strength when I thought of giving up, who continually provide my moral,
spiritual, emotional, and financial support. To my clinical Instructor Ma’am Sonia Delantar, who
help me and provide a format to make a final output . To Almighty God, thank you for guidance,
strength, power of mind, protection, skills and for giving me a healthy life. To the Nursing
student and Future researcher’s, who can use this case study as their guide or reference.
III. Objectives

To define Placenta Previa and its causes.

To Identify possible risk factors for Placenta Previa

Describe appropriate prevention and treatment of Placenta Previa.

Describe the implications of Placenta Previa on the health and well-being of the mother and
her new baby.
3
IV. Introduction
Placenta previa
The placenta is a structure that develops in the uterus during pregnancy, providing oxygen and
nutrition to and removing wastes from your baby. The placenta connects to your baby through
the umbilical cord. The placenta grows during pregnancy and feeds the developing baby. The
cervix is the opening to the birth canal.
In most pregnancies, the placenta is located at the top or side of the uterus. In placenta previa, the
placenta is located low in the uterus. The placenta might partially or completely cover the cervix,
as shown here. Placenta previa can cause severe bleeding in the mother before or during delivery.
A C-section delivery might be required. Placenta previa occurs when a baby's placenta partially
or totally covers the mother's cervix the outlet for the uterus. Placenta previa can cause severe
bleeding during pregnancy and delivery. 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.
Causes
During pregnancy, the placenta moves as the womb stretches and grows. It is very common for
the placenta to be low in the womb in early pregnancy. But as the pregnancy continues, the
placenta moves to the top of the womb. By the third trimester, the placenta should be near the top
of the womb, so the cervix is open for delivery.
Sometimes, the placenta partly or completely covers the cervix. This is called a previa.
There are different forms of placenta previa:
Marginal: The placenta is next to the cervix but does not cover the opening.
Partial: The placenta covers part of the cervical opening.
Complete: The placenta covers all of the cervical opening.
Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:

An abnormally shaped uterus

Had many pregnancies in the past

Had multiple pregnancies, such as twins or triplets



Scarring on the lining of the uterus due to a history of surgery, C-section, or abortion
In vitro fertilization
Women who smoke, use cocaine, or have their children at an older age may also have an
increased risk.
4
Symptoms


Bright red vaginal bleeding without pain during the second half of pregnancy is the main sign
of placenta previa. Some women also have contractions.
In many women diagnosed with placenta previa early in their pregnancies, the placenta previa
resolves. As the uterus grows, it might increase the distance between the cervix and the placenta.
The more the placenta covers the cervix and the later in the pregnancy that it remains over the
cervix, the less likely it is to resolve.
Risk factors
Placenta previa is more common among women who:


Have had a baby
Have scars on the uterus, such as from previous surgery, including cesarean deliveries, uterine
fibroid removal, and dilation and curettage

Had placenta previa with a previous pregnancy

Are carrying more than one fetus

Are age 35 or older

Are of a race other than white

Smoke

Use cocaine
Complications



If you have placenta previa, your health care provider will monitor you and your baby to reduce
the risk of these serious complications:
Bleeding. Severe, possibly life-threatening vaginal bleeding (hemorrhage) can occur during
labor, delivery or in the first few hours after delivery.
Preterm birth. Severe bleeding may prompt an emergency C-section before your baby is full
term.
Exams and Tests

Your health care provider can diagnose this condition with a pregnancy ultrasound.
Treatment


Your provider will carefully consider the risk of bleeding against early delivery of your baby.
After 36 weeks, delivery of the baby may be the best treatment.
Nearly all women with placenta previa need a C-section. If the placenta covers all or part of the
cervix, a vaginal delivery can cause severe bleeding. This can be deadly to both the mother and
baby.
If the placenta is near or covering part of the cervix, your provider may recommend:
5

Reducing your activities

Bed rest

Pelvic rest, which means no sex, no tampons, and no douching

Nothing should be placed in the vagina.

You may need to stay in the hospital so your health care team can closely monitor you and your
baby.
Other treatments you may receive:

Blood transfusions

Medicines to prevent early labor

Medicines to help pregnancy continue to at least 36 weeks

Shot of special medicine called Rhogam if your blood type is Rh-negative

Steroid shots to help the baby's lungs mature

An emergency C-section may be done if the bleeding is heavy and cannot be controlled.
V. Patients Data
Name: Patient G
Age: 30 y.o.
Sex: Female
Birthdate: January 12, 1990
Marital Status: Married
Address: Bgry. 6 Evangelista St. Lucena City, Quezon Province
Religion: Roman Catholic
Citizenship: Filipino
Height:5’6 ft
Weight: 57 kg
Parity (GP): G3 P2
LMP: May 1, 2020
EDC: February 7, 2021
AOG: 42 weeks 2/7 days age of gestation
Chief complaints upon admission: Painless vaginal bleeding with bright red blood.
Diagnosis: Placenta Previa
Attending Physician: Dr. Maria Teresa Obispo Corpuz
Date Initiated: October 10, 2021
6
Care plan by: Gleisy G. Saguno
Date admitted: October 10, 2020
VI. Physical Assessment
Head and Neck:
 Facial symmetry
 Absence of scalp tenderness
 Absence of lesions nor masses noted
 Iris are black, pupils are equally round and reactive to light accomodation
 With white and clear sclera
 Pinna is the same as color with the fscial skin, smooth and aligned with eye level
 Able to hear sound clearly as claimed
 Absence of pain, inflamation or drainages
 With patent and clear nostrils
 Absence of nasal flaring, congestion or drainages
 Tongue and uvula are centrally positioned
 Lingual tonsils at the posterior portion of the tongue.
 Has good oral hygiene, no halitosis
 Jugukar vain not destended
 No swollen lymph nodes as palpated
Thorax:
 Symmetrical chest wall upon movement and breathing on room air
 Breath sounds are clear
Cardiovascular:
 Absence of chest pain
 Normal peripheral pulse
Genitourinary:
 Minimal vaginal sotting up to 2-3 pads per day
 No discharges nor foul smell
7
 Able to void freely
 Urine is clear
 No pain in urination
Gastrointestnal:
 Mild hypogastrip pain
 Abdomen is soft
 With mild to moderate uterine contraction
 With active bowel sounds
 No abdominal tenderness
Musculoskeletal:
 No Physical deformities nor paralysis
 With active ROM
 Joints can move freely without any resistance or pain
Neurologic:
 Awake, alert and orianted to time, person and place
 Understands written and spoken language and responds accurately
 Able to follow commands
General Appearnace:
 Well
 Cooperative
 Weak-looking
Vital Signs:
Temperature:36.9
PR:60
RR:14
BP:100/60mmHg
8
VII. Laboratory Result/ Diagnostic Result
DIAGNOSTIC
TEST/PROCEDURE
PATIENT’S RESULT
NORMAL
VALUE/RESULT
CBC:
WBC
14.64
3.98-10.04
RBC
4.22
3.93-5.22
HGB
11.8
11.2-15.7
HCT
34.6
34.1-44.9
PLT
403
182-369
PATIENT
11.7
10-17
PT:
CONTROL
14.8
INR
0.83
2-4(therapeutic)
PATIENT
36.2
26.1-36.3
CONTROL
35.1
APTT:
ABO RH
O POSITIVE
ANTI BODY SCREEN
NEGATIVE
NEGATIVE
RPR
NON-REACTIVE
NON- REACTIVE
HBSAG
NON-REACTIVE
NON-REACTIVE
9
Diagnostic Result
Transvaginal Ultra Sound in plancenta Previa
Placenta covers internal os and extends over the os by over 5 cm. This type will not migrate
sufficiently by term and will likely require a cesarean section.
Placenta covers internal os and extends over the os by under 2 cm. This type will often migrate
sufficiently by term and allow vaginal delivery.
10
Pitfall in the Diagnosis of Placenta Previa
A prominent myometrial contraction in the lower uterine segment adjacent to the placenta may
simulate a previa. The echotexture of the contaction is usually slightly different to the placenta,
and resolution over time will usually help distinguish contraction from previa.
11
VIII. Anatomy and Physiology
The placenta is normally implanted into the wall of the uterus where there are many blood
vessels that supply the baby with oxygen and nutrients.
Placenta is normally located in the upper part of the uterus. With marginal placenta previa, the
placenta implants near the bottom part off the uterus and may block part of the cervix. The baby
may need to be delivered by caesarean section.
12
IX. Pathophysiology
13
X. Medical Management
14
15
Medical Management- Depends on the Gestational age and severity of bleed.
A. Strict bedrest
B. IV - large bore catheter (16 gauge)
C. CBC, type & screen, platelet count, fibrinogen, bleeding time
D. If HCT less than30% tranfuse
E. No Pelvic Examinations
F. Adequate hydration, accurate I & O
G. Frequent Vital Signs
H. Ultrasound
I. Restore blood loss, correct coagulation defect
Treatment of placenta previa involves bed rest and limitation of activity. Tocolytic medications,
intravenous fluids, and blood transfusions may be required depending upon the severity of the
condition.
16
XI. Nursing Care Plan
Deficient Fluid Volume
related to Active Blood Loss Secondary
to Disrupted Placental Implantation
Assessment
Diagnosis
Planning
Subjective:
Deficient
Fluid
Volume
related to
Active
Blood
Loss
Secondary
to
Disrupted
Placental
Implantati
on
Within 8
hours of
Nursing
intervention
the Patient
will maintain
fluid volume
at a functional
level possibly
evidenced by
adequate
urinary output
and stable
vital signs.
“Ang dami
pong
lumalabas na
dugo sa
puerta ko, di
parin
tumitigil
yung
pagdaloy at
pag agos ng
dugo”.- As
verbalized by
the patient.
Objective:



Bleeding
episodes
(100 ml), 24
hrs duration
Abdomen
hard when
palpated
Manifests
body
weakness
Intervention

Independent
Establish Rapport
Monitor Vital
Signs

Assess color,
odor, consistency
and amount of
vaginal bleeding;
weigh pads.


Assess
hourly intake and
output.
To gain patient’s
trust

To obtain baseline
data

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.

Assess abdomen  Detecting
for tenderness or
increased in
rigidity- if present, measurement of
measure abdomen
abdominal girth
at umbilicus
suggests active
(specify time
abruption.
interval)


Assess baseline
data and note
changes. Monitor
FHR.
Rationale
Assess SaO2, skin
color, temp,


Evaluation
The Goal
Met after 8
hours of
nursing
intervention
the:
Patient
maintain
fluid volume
at a
functional
level as
evidenced
by adequate
urinary
output and
stable vital
signs.
T:37°C
RR:18 cpm
PR: 80 bpm
BP:120/80
mmHg
Assessment
provides
17




Fetal heart
rate less
than normal
(90 bpm)
moisture, turgor,
capillary refill.

Decreased
urine output
Increased
urine
concentratio
n
Pale, cold,
clammy
skin
Vital Signs:
Temperature:
36.9 °C
PR:60
RR:14
BP:100/60m
mHg
Assess for
changes in LOC:
note for complaints
of thirst or
apprehension
Dependent:
Provide
supplemental O2 as
ordered via face
mask or nasal
cannula at 10-12
L/min.

Initiate IV
fluids as ordered.
information about
blood vol., O2
saturation and
peripheral perfusion.

To detect signs of
cerebral perfusion.


Intervention
increases available
O2 to saturate
decreased
hemoglobin.
For replacement of
fluid vol. Loss.
Position decreases
pressure on placenta
and cervical os. Left
lateral position
improves placental
perfusion.

Monitor lab. Work  Lab Work provides
as obtained: Hgb & information about
Hct, Rh and type,
degree of blood loss;
cross match for 2
prepares for possible
units RBCs,
transfusion.
urinalysis, etc.
Ultrasound provides
Scheduled for
info about the cause
ultrasound as
of bleeding
ordered.

Position Pt.
in supine with hips
elevated if ordered
or left lateral
position.


18
Decreased cadiac output
related to altered contractility
Assessment
Subjective:
“Ang dami
pong
lumalabas na
dugo sa
puerta ko, di
parin
tumitigil
yung
pagdaloy at
pag agos ng
dugo”.- As
verbalized by
the patient.
Objective:






Dysrhythmi
as
Prolonged
capillary
refill
cold
clammy skin
Diagnosis
Decreased
cadiac
output
related to
altered
contractilit
y
Planning
Intervention
Within the 8 Independent:
hours
of  Establish Rapport
nursing
 Monitor Vital
intrvention
Signs
the:
 History taking
will
 Patient
 Assess patient
participate
condition
and
 Review lab data
demonstrate
activities
that reduce
 Monitor BP &
the workload
Pulse frequently
of the heart.
 Provide
will information on test
 Patient
procedures
manifest
 Provide adequate
hemodynami
rest & Reposition
c stability.
client
 Encourage relaxati
on techniques
 Elevate HOB

Encourage use of
relaxation
techniques
Rationale
Evaluation
The Goal
 To gain patient’s
Met after
trust
the 8
 To obtain baseline
hours of
data
nursing
 To determine
intrvention
contributing factors
the:
 To assess
contributing factors
 For comparison
 Patient can
with current
participate
normal values
and
 To note response to
activity
demonstra
 To gin patient’s
te
participation
activities
that reduce
 To promote venous
the
return
workload
of the
 To alleviate stress
heart.
& anxiety


To promote
circulation

To decrease
tension level
Dyspnea
Restlessness
Variations
in
BP
reading
Vital Signs:
T: 36.9°C
PR:60
RR:14

Patient can
manifest
hemodyna
mic
stability as
evidenced
by a vital
sign of
BP:
120/80
mmHg
PR: 80
bpm
19
BP:100/60m
mHg
Ineffective tissue perfusion
related to decreased HgB concentration in blood and hypovolemia
Assessment
Diagnosis
Planning
Intervention
Subjective:
“Ang dami
pong
lumalabas na
dugo sa
puerta ko, di
parin tumitigil
yung
pagdaloy at
pag agos ng
dugo”.- As
verbalized by
the patient.
Ineffective
tissue
perfusion
related to
decreased
HgB
concentrati
on in
blood and
hypovole
mia
Within 8
hours of
nursing
intervention
the:
 Patient will
demonstrate
behaviors to
impove
circulation.
 Patient will
demonstrate
increased
perfussion as
individually
appropriate
Independent :
 Establish Rapport
Objective:






Restlessness
Confusion
Irritability
Manifest
Body
Weakness
Capillary
refill more
than 3 sec
Oliguria
Vital Signs:
Monitor Vital
Signs
 Assess patient
condition
 Note customary
baseline data, BP,
weight, lab.

Determine
presence of
dysrhythmias
 Perform blanch
test
Rationale
To gain patient’s
trust
 To obtain baseline
data
 To assess
contributing factors
 For comparison
with current
findings

To identify
alterations from
normal
 To identify and
determine adequate
perfusion
 Check for
 To determine
Homan’s Sign
presence
of thrombus formati
on.
 Encourage quiet &
 To lessen O2
restful environment demand
 Elevate HOB
 To promote
circulation
 Encourage use of
 To decrease
relaxation
tension level
techniques

Evaluation
The Goal
was met
after the 8
hours of
nursing
intervention
the:


Patient
demonstrat
e
behaviors
to impove
circulation
.
Patient
demonstrat
e increased
perfussion
as
individuall
y
appropriat
e as
evidence
by a vital
signs of
T:37°C
PR: 80 bpm
RR:18 cpm
BP:120/80
mmHg

20
T: 36.9 °C
PR:60
RR:14
BP:100/60m
mHg
FDAR
Date
10/10/20
9:00 am
Focus
Deficient Fluid Volume
related to Active Blood
Loss Secondary to
Disrupted Placental
Implantation
Data, Action, Responce
D:“Ang dami pong lumalabas na dugo sa puerta ko, di
parin tumitigil yung pagdaloy at pag agos ng dugo”.- As
verbalized by the patient. Appears pale, cold, clammy
skin, manifests body weakness. Has decreased urine
output and increased urine concentration. With the
bleeding episodes of 100 ml in 24 hrs duration. The
abdomen is hard when palpated. Fetal heart rate less than
normal (90 bpm).Vital signs of T:36.9°C, PR:60, RR:14
BP:100/60mmHg.
A: Establish Rapport, monitor Vital Signs, assess color,
odor, consistency and amount of vaginal bleeding; weigh
pads, assess hourly intake and output, assess baseline
data and note changes. monitor FHR, assess abdomen for
tenderness or rigidity- if present, measure abdomen at
umbilicus, assess SaO2, skin color, temp, moisture,
turgor, capillary refill, assess for changes in LOC: note
for complaints of thirst or apprehension, provide
supplemental O2 as ordered via face mask or nasal
cannula at 10-12 L/min., Initiate IV fluids as ordered,
position Pt. in supine with hips elevated if ordered or left
lateral position, monitor lab., work as obtained: Hgb &
Hct, Rh and type, cross match for 2 units RBCs,
urinalysis, etc. Scheduled for ultrasound as ordered.
R: Patient maintain fluid volume at a functional level as
evidenced by adequate urinary output and stable vital
signs. T:37°C, RR:18 cpm, PR: 80 bpm, BP:120/80
mmHg
21
XII. Drug Study
Ferrous Sulfate
Therapeutic
Action
Contraindication
Generic name: Ferrous
Conditions:
Ferrous
sulfate replaces  A high amount of
Sulfate
iron, an
oxalic acid in
essential
urine
component in
 Iron metabolism
the formation
disorder causing
of hemoglobin.
increased iron
Brand
storage
name:Feosol
iron supplement  Sickle cell
used to treat or
anemia
 Anemia from
Classification: prevent low
pyruvate kinase
Iron Products blood levels
of iron
and G6PD
deficiencies an
overload of iron
in the blood
 A type of blood
disorder where
the red blood
cells burst called
hemolytic anemia
 An ulcer from
too much
stomach acid
 Ulcerative colitis
 An inflammatory
condition of the
intestines
 Problems with
food passing
through the
esophagus
 Diverticular
disease
 Excess iron due
to repeated blood
transfusions
Toxicity








Constipation
Dark stools
Diarrhea
Stomach
pain
Stomach
cramps
Indication

Irondeficiency
anaemia
Safe Dose
Dosage:
mg
Route:PO
Frequency:
TID
Upset
stomach
Nausea
Vomiting
22
27
Sodium Chloride
Therapeutic
Generic name:

Sodium
Chloride
0.9 %
Brand Name:
Sterile Saline
Diluent TipLok Syringe
Syrex
Classification:
Normal Saline





Action
Contraindication
Sodium
Chloride used
as an additive
for total
parenteral
nutrition
(TPN) and
carbohydratecontaining IV
fluids.
Contraindicated in
patients with:
Absorb and
transport
nutrients

Maintain bloo
d pressure
Maintain the
right balance
of fluid
Transmit
nerve signals





Congestive heart
failure
Severe renal
impairment
Toxicity




Conditions of
sodium retention
Edema
Liver cirrhosis
Redness
Pain
Swelling at
the injection
site
Swelling
hands/ankles
/
Feet

Irrigation during
electrosurgical
procedures



Contract and
relax muscles





Muscle
cramps
unusual wea
kness
headache
Nausea
Extreme
drowsiness
Mental/moo
d changes
(such as
confusion)
Indication
Safe Dose
Indicated for As directed by
the treatment a physician.
of hypertonic
extracellular
dehydration
 Dosage is
or
dependent
hypovolaemi
upon the age,
a
weight and
clinical
 Sodium Chlo
condition of
ride Injection
the patient as
.
well
as laboratory
 Indicated as
a source of
determinatio
water and
ns.
electrolytes.
 Dosage 250
to 500
 Indicated
for use as a
ml/hour.
priming
 Route: IV
solution
in hemodialy  Frequency:
sis procedure PRN
s.

Seizures
Vein
irritation
Thrombophl
ebitis
Extravasatio
n of solution
may cause
tissue injury.
Allergic
23
reaction,
including: ra
sh, itching/s
welling
(especially
of the
face/tongue/t
hroat)


Severe dizzi
ness
Trouble
breathing
Magnesium Sulfate
Therapeutic
Generic
Name:
Magnesium
Sulfate
Brand name:
MgSO4
Classification:
Mineral and
electrolyte
replacements/
supplements
Action

Contraindication
Toxicity
Magnesium
Conditions:
 Circulatory
sulfate is a
collapse
amount of
 High
nutritional
 Respiratory
supplement in magnesium in the
paralysis
hyperalimentat blood
ion. It is a  Low amount of  Hypothermia
cofactor
in
calcium in the  Pulmonary
enzyme
blood
edema
systems
involved
in  Myasthenia gravis  Depressed
neurochemical
reflexes
 A skeletal muscle
transmission
disorder
 Hypotension
and muscular
 Progressive
excitability.
Flushing
muscle weakness
 Drowsiness
with carcinoma


Decreased kidney
function
Severe
renal
impairment




Indication
Safe Dose
Indicated for
replacement
therapy
in
magnesium
deficiency
Dosage:
12g/h
intravenously
(IV)
Route: IV
Frequency:
STAT
Depressed
cardiac
function
Diaphoresis
Hypocalcem
ia
24



Hypophosph
atemia
Hyperkalemi
a
Visual
changes
Dexamethasone Acetate
Therapeutic
Action
Contraindication
Generic
name:
Dexamethaso
ne Acetate
Dexamethasone
may be given to
promote the
development of
the lungs in the
fetus.
Contraindicated in
patients
hypersensitive to
drug or its
components and in
those with
systemic fungal
infections.
Brand name:
Decadron
DSC
Dexamethasone
stimulates the
synthesis of
Classification enzymes needed
to decrease the
:antiinflammatory inflammatory
response.
immunosuppr
essant
Toxicity








Increased
appetite
Irritability
Difficulty
sleeping
(insomnia)
Indication

Inflammatory
conditions,
allergic
reactions,
neoplasias,
dexamethason
e (systemic)
Safe Dose
Injectable
suspension
4mg/mL
(generic)
10mg/mL
(generic)
Swelling in
your ankles
and
feet
(fluid
retention)
Dosage:10
mg
Heartburn
Route: Oral
Muscle
weakness
Impaired
wound
healing
Frequency:
TID
Increased
blood sugar
levels
25
Medication Card
26
XIII. Discharge Plan
Patient Education:

Counsel patients with placenta previa about the risk of recurrence, and instruct them to
notify the obstetrician caring for their next pregnancy regarding their history of placenta
previa.
Medicines:




Tocolytics: Tocolytics are given to stop contractionsbecause your baby is not ready to be born.
Contractions are when the muscles of your uterus tighten and loosen.
Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by bacteria.
Antibiotics may be needed before you give birth if you have an infection in your uterus. You
may also need antibiotics after your baby has been born.
Blood thinners: Blood thinners prevent clots from forming in your blood. They may be given if
you are at risk for deep vein thrombosis (DVT). DVT is a condition in which clots form inside
your blood vessels.
Take your medicine as directed. Contact your healthcare provider if you think your medicine is
not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep
a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why
you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with
you in case of an emergency.
Follow up with your obstetrician as directed:

You may need to return for repeat ultrasounds. Write down your questions so you remember to
ask them during your visits.
Manage placenta previa:


You may need to be on bedrest until your baby is born. Ask your healthcare provider which
activities you may do while you are on bedrest.
Do not douche or have sex. These may cause bleeding.
Safety plan:

You will need to have a safety plan until your baby is born. Make sure you live, or are staying a
short distance away from the hospital. You will also need to make sure someone is ready to
take you to the hospital if needed.
Contact your obstetrician if:

You feel abdominal cramps, pressure, or tightening.

Your heart is beating faster than normal for you.

You have questions or concerns about your condition or care.
27
Seek care immediately or call 911 if:

You have any amount of bleeding from your vagina.

You are having severe abdominal pain or contractions.

You feel faint or too weak to stand up.

You suddenly feel lightheaded and short of breath.

You have chest pain when you take a deep breath or cough.

You cough up blood.
Further information

Always consult your healthcare provider to ensure the information displayed on this page
applies to your personal circumstances.
XIV. Prognosis
Patient G was diagnosed with Placenta Previa after several diagnostic procedures. After 2
days of applying intervention to patient G in the hospital, the patient was stable and reduce
further signs and symptoms occurred. Reduce the pain and bleeding of the cervix. Patient G
maintain fluid volume at a functional level as evidenced by adequate urinary output and stable
vital signs.Patient G demonstrate behaviors that impove circulation. Upon discharge, patients
VS are as follow: BP 120/80, HR 85 bpm, RR 20 bpm and temperature of 36.8 degrees celsius.
This concludes that the patient has a good prognosis.
28
XV. Reference
rancois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Landon MB, Galan HL,
Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 7th ed.
Philadelphia, PA: Elsevier; 2021:chap 18.
Hull AD, Resnik R, Silver RM. Placenta previa and accreta, vasa previa, subchorionic
hemorrhage, and abruptio placentae. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel
JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th
ed. Philadelphia, PA: Elsevier; 2019:chap 46.
Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS,
Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed.
Philadelphia, PA: Elsevier; 2018:chap 178.
https://medlineplus.gov/ency/article/000900.htm?fbclid=IwAR24TI6Gy8BoSYb78vapkvCx13y0Aa1nVGj9jZmt0Xms58I8q2JKrlBPkc
http://www.fetalultrasound.com/online/text/33032.htm?fbclid=IwAR1Xztiu2bPh7fR_ieG2ZpZqOO8szCh8JNpTOHCwjeHPSvOgokmWu_oOs4
https://www.drugs.com/cg/placenta-previa-discharge-care.html
https://nurseslabs.com/3-placenta-previa-nursing-care-plans/
https://www.msdmanuals.com/professional/gynecology-and-obstetrics/abnormalities-ofpregnancy/placenta-previa
https://emedicine.medscape.com/article/262063-medication#1
https://medlineplus.gov/ency/article/000900.htm
https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc20352768#:~:text=Placenta%20previa%20(pluh%2DSEN%2D,pregnancy%20and%20during%2
0your%20delivery.
https://www.medscape.com/answers/260998-168209/what-are-the-most-common-tocolyticagents-used-to-treat-preterm-labor
https://go.drugbank.com/categories/DBCAT000759
https://www.mayoclinic.org/drugs-supplements/sodium-chloride-injection-route/description/drg20068846
https://www.webmd.com/drugs/2/drug-145556/sodium-chloride-0-9-intravenous/details
https://www.parents.com/pregnancy/complications/health-and-safety-issues/placenta-previa/
29