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What is Placenta Previa And Its Assessment:Nursing Case Study

Thursday, 13 March 2014

In placenta previa, the placenta is attached low in the uterus over or near the internal cervical os. The degree of severity depends on placental placement. The least severe degree is low implantation or low‑lying placenta, in which the placenta is implanted in the lower uterine segment close to the os. Marginal placenta previa, in which the placenta encroaches on but doesn't occlude the os, is the next degree of severity. A partial or incomplete placenta previa, in which the placenta partially occludes the os, is third in severity degree. The most severe degree of placental placement is total or central placenta previa, in which the placenta completely occludes the os.

Pathophysiology
Uterine segment differentiation later in pregnancy causes the lower section of the uterus to lengthen and thin. Placental villi tear, and bleeding occurs from open uterine sinuses.

Confirmed placenta previa associated with minimal vaginal bleeding early in the third trimester may be treated conservatively with bed rest, allowing the fetus time to mature. Uncontrolled vaginal bleeding, fetal distress, or loss of fetal viability warrants delivery. Labor may be spontaneous or induced by amniotomy. The mother may deliver vaginally if gestational age is 37 weeks or more or if fetal lung maturity has been established by lecithin-sphingomyelin ratio, the cervix is partially dilated, there's a low presenting fetal part, and bleeding is minimal or controlled. Cesarean section is necessary if the placenta is felt on cervical examination; if the mother has massive, uncontrolled bleeding; or if the fetus is in distress.

Complications
■ Hemorrhage
■ Shock
■ Preterm delivery

Assessment
Health perception and management

■ Sensation of thirst or cold
■ Apprehension

Physical examination
Mental status and behavior
■ Anxiety

Integumentary
■ Cold, moist skin
■ Dry mucous membranes

Respiratory

■ Tachypnea

Cardiovascular
■ Tachycardia
■ Hypotension
■ Vertigo
■ Syncope
■ Diaphoresis
■ Pallor
■ Cyanosis

Neurologic
■ Restlessness
■ Lethargy
■ Confusion
■ Somnolence

Reproductive
■ Painless, bright red, scant to profuse vaginal bleeding in third trimester
■ Soft, nontender uterus
■ Fetal malpresentation (oblique, breech, or transverse)
■ Fundal height greater than normal for gestational age; placental hindering of fetal descent
■ Oliguria or anuria

Diagnostic studies
■ Ultrasonography reveals placental implantation site, fetal viability, gestational age, position, and station.
■ X‑rays may reveal soft-tissue density in front of the presenting fetal part.
■ Hemoglobin (Hb) level and hematocrit (HCT) decrease due to bleeding.
■ Coagulation factors are usually within normal limits.

Teaching checklist
■ Placental abnormality and significance for term birth and healthy neonate
■ Signs and symptoms to report to the practitioner
■ Laboratory and diagnostic findings, including tests for fetal and maternal status
■ Blood loss tracking, including amount and color
■ Fetal activity level monitoring
■ Treatment procedures and associated nursing care
■ Neonatal care after birth
■ Resources available for support in the community or online.


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