Chapter 11: Placenta Previa

Question 1

What is Placenta Previa?

Answer 1

hemorrhagic disorder

-implantation of the placenta in the lower uterine segment, near or over the internal cervical os

Question 2

Early Identification of Early Hemorrhage

Answer 2

during pregnancy, a woman’s blood volume increases 50%, and in the case of multiple gestation, it increases as much as 100%
>because of this expanded blood volume, the patient may be asymptomatic and exhibit vital signs that remain within normal parameters despite a large amount of blood loss
-BP = poor indicator of blood volume deficit
-The maternal pulse (tachycardia) and/or fetal HR (bradycardia or tachycardia) may be the first indicators of maternal instability

Question 3

What is the first indicators of maternal instability?

Answer 3

maternal pulse (tachycardia) and/or fetal HR (bradycardia or tachycardia)

Question 4

3 Variations of Placenta Previa

Answer 4

• Complete (total) Placenta Previa
• Partial Placenta Previa
• Marginal Placenta Previa

Question 5

Complete (total) Placenta Previa

Answer 5

placenta covers the entire cervical os

-because it is associated with the greatest amount of blood loss, it presents the most serious risk

Question 6

Partial Placenta Previa

Answer 6

partially occludes the cervical os

Question 7

Marginal Placenta Previa

Answer 7

the encroachment of the placenta to the margin of the cervical os, and a low-lying placenta is one that is implanted in the lower uterine segment in close proximity to the internal cervical os

Question 8

Etiology (Why it could happen)

Answer 8

• conditions that cause scarring of the uterus such as a prior cesarean birth or previous abortions with curettage (the use of a curette to remove tissue by scraping or scooping)
• large placental mass as seen in multiple gestations, diabetes, and erythroblastosis fetalis

Question 9

Risk Factors

Answer 9

• smoking
• cocaine use
• hx of placenta previa
• closely spaced pregnancies
• African or Asian ethnicity
• maternal age greater than 40

Question 10

Signs and Symptoms

Answer 10

painless vaginal bleeding
>occur from small disruptions in the placental attachment during normal development and the subsequent stretching and thinning of the lower uterine segment during the third trimester
>initially, the bleeding is usually a small amount that stops as the uterus contracts to close the open blood vessel. However, Bleeding can reoccur at any time and may be associated with profuse hemorrhage and shock that leads to maternal and fetal morbidity and mortality; blood is bright red

Question 11

How to Diagnose Placenta Previa

Answer 11

Transvaginal Ultrasound (TVU); with bladder empty
-In patients diagnosed before 24 weeks gestation, a repeat ultrasound should be scheduled between 24 and 28 weeks gestation to confirm diagnosis
>if patients experience vaginal bleeding during this time interval, they should be managed as presumed cases
>Placenta previa should be suspected in all patients who present with bleeding after 24 completed weeks of gestation
>sometimes a low-lying placenta present on TVU in the second trimester no loner have the condition at term (because of the expanding uterus)

Question 12

With Placenta Previa, Why should Vaginal Examinations be Avoided?

Answer 12

because of the risk pf placental perforation
-nurse should advise any patient with a known or suspected placenta previa to inform medical personnel that vagina examinations are prohibited

Question 13

When A nurse performs Leopold Maneuvers on a patient with placenta previa what does it reveal?

Answer 13

reveals the fetus to be in a breech or oblique position or transverse lie because of the abnormal location of the placenta

Question 14

Stabilization/Management involves

Answer 14

• Administration of IV fluids
• Laboratory work-up: CBC, prothrombin time, partial thromboplastin time, fibrin split products, and fibrinogen
• a blood type and crossmatch in case for anticipation for a transfusion
• a maternal Kleihauer-Betke blood test may be ordered to determine if there has been a transfer of fetal blood cells into the maternal circulation
• patient placed on Bedrest
• fetus is continually assessed by electronic fetal monitoring

Question 15

Laboratory Work-Up

Answer 15

-CBC
-prothrombin time
-partial thromboplastin time
-fibrin split products
-fibrinogen
>a blood type and crossmatch is case for anticipation for a transfusion

Question 16

Maternal Kleihauer-Betke Blood Test

Answer 16

may be ordered to determine if there has been a transfer of fetal blood cells into the maternal circulation
>If the patient is Rh negative and unsensitized, Rho(D) immune globulin (RhoGAM) should be administered even if the blood type of the baby cannot be determined; RhoGAM will cause no harm to the woman or fetus if the fetus is RH(D)-negative

Question 17

Betamethasone

Answer 17

long-acting corticosteroid

-may be administered to the woman to promote fetal lung maturity

Question 18

What are indications for Immediate Delivery Regardless of Gestational Age?

Answer 18

labor that cannot be halted, fetal compromise, and life-threatening maternal hemorrhage

Question 19

Recognizing Maternal Stress factors associated with Placenta Previa

Answer 19

• nurse should recognize various manifestations of maternal stress associated with the diagnosis (e.g. anxiety, feelings of helplessness, fear of pregnancy loss, fear for self, confusion and panic, and difficulty making decisions)
• nurses can be instrumental in helping to assuage anxiety by speaking calmly to the patient and her support persons; carefully explaining her condition (using pictures, images, and other resources of the health-care team), describing planned interventions and why they are being performed; providing preparatory educational videotapes and reading materials regarding pregnancy, childbirth, infant care, and post partum self-care; and offering reassurances and instructions for home care when appropriate