PLACENTA PREVIA Flashcards
It is an organ that develops in the uterus during pregnancy
- provides oxygen & nutrients to a growing baby.
- removes waste products from the baby’s blood
- serves as the baby’s lungs in utero
Placenta
Why does the placenta attach to the fundal area of the uterus?
Increased blood supply
A condition wherein the placenta abnormally attaches in the LUS, covering or being near the cervical opening
Placenta Previa
Types of Placenta Previa
1) Total / Complete
2) Partial
3) Marginal
Placenta attaches completely over the cervical opening
Total / Complete
Placenta is partially cover the cervical opening.
Partial
Placenta is attached at the edge of the cervical opening
Marginal
Causes / Risk Factors of Placenta Previa
- History of placenta previa
- Multiple pregnancies
- Maternal age >35 yrs.old
- Illegal drug use, smoking
- Scarring from previous surgeries like Cesarean sections or removal of fibroids / tumors ; repeated D&Cs
Main diagnostic tool to help confirm position of the placenta
Ultrasound
A 20-week ultrasound would reveal?
May reveal placenta previa but will eventually resolve as the uterus gorws & expands & the placenta migrates upward
When to do a repeat scan or re-evaluation of the location of the placenta
30-32 weeks ultrasound
Diagnosis & Management for no placenta previa
- Located >2cm away from the cervical opening
- Labor & NSD is generally safe (C-section for other indications)
Diagnosis & Management for Marginal Placenta Previa
- Located at the edge of the cervix
- NSD can be attempted but OR set-up must be available in case of emergency
Diagnosis & Management for Partial or Total Placenta Previa
- C-section indicated
- NSD should not be attempted
Signs & Symptoms of Placenta Previa
- Painless bright red bleeding
- Relaxed, soft uterus; non-tender
- Episodes of bleeding due to thinning of cervix
- Visible bleeding - blood gushes out of the vagina
- Intercourse-related bleeding
- Abnormal fetal position, FHT normal
Nursing Interventions
- Advise pelvic rest
- If no bleeding or light bleeding : bed rest
- If bleeding: hospitalization needed
Nursing Interventions during Hospitalization
- Anticipate for initiation of IV access or blood transfusion
- Follow-up Lab Results
- Monitor Fetal & Maternal Well-Being
- Place woman in LLD position
- Anticipate for cesarean section delivery with hysterectomy
- assist in FLM tests
- Administer Medications as ordered
A pregnancy complication that occurs when the placenta attaches too deeply to the uterine wall.
Placenta accreta
Management of placenta accreta
- Early diagnosis
- Close monitoring of mother and baby
- Planned cesarean delivery
- Possibility of BT due to increased risk of massive bleeding
- In certain cases, hysterectomy is performed
Placenta grows into the uterine muscle
Placenta increta
Placenta grows through the uterine wall and may grow into other organs.
Placenta percreta
Which of the following is the most common kind of placental adherence seen in pregnant women?
A. Accreta
B. Placenta previa
C. Percreta
D. Increta
A. Accreta
A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?
A. Placenta previa
B. Abruptio placentae
C. Ectopic pregnancy
D. Spontaneous abortion
B. Abruptio placentae
The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?
A. Change the client’s position.
B. Prepare for emergency cesarean section.
C. Administer oxygen.
D. Check for placenta previa.
A. Change the client’s position.
A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?
A. Activity limited to bed rest
B. Platelet infusion
C. Immediate cesarean delivery
D. Labor induction with oxytocin
A. Activity limited to bed rest
A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:
A. Hematoma
B. Placenta previa
C. Uterine atony
D. Placental separation
D. Placental separation
A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?
A. Disseminated intravascular coagulation
B. Chronic hypertension
C. Infection
D. Hemorrhage
D. Hemorrhage
A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician’s orders and would question which order?
A. Prepare the client for an ultrasound
B. Obtain equipment for external electronic fetal heart monitoring
C. Obtain equipment for a manual pelvic examination
D. Prepare to draw a Hgb and Hct blood sample
C. Obtain equipment for a manual pelvic examination
Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
a. Placenta previa
Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa?
a. Amniocentesis
b. Digital or speculum examination
c. External fetal monitoring
d. Ultrasound
d. Ultrasound
The common normal site of nidation/implantation in the uterus is:
A. Upper uterine portion
B. Mid-uterine area
C. Lower uterine segment
D. Lower cervical segment
A. Upper uterine portion
A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that the placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding:
A. This is known as marginal placenta previa.
B. The placenta may move upward as the pregnancy progresses and needs to be re-evaluated with another ultrasound at about 32 weeks gestation.
C. The patient will need to have a c-section and cannot deliver vaginally.
D. The woman should report any bleeding immediately to the doctor.
C. The patient will need to have a c-section and cannot deliver vaginally.
Your patient who is 34 weeks pregnant is diagnosed with total placenta previa. The patient is A positive. What nursing interventions below will you include in the patient’s care? Select all that apply:
A. Routine vaginal examinations
B. Monitoring vital signs
C. Administer RhoGAM per MD order
D. Assess internal fetal monitoring
E. Placing patient on side-lying position
F. Monitoring pad count
G. Monitoring CBC and clotting levels
B.
F.
G.
Select all the signs and symptoms associated with placenta previa:
A. Painless bright red bleeding
B. Concealed bleeding
C. Hard, tender uterus
D. Normal fetal heart rate
E. Abnormal fetal position
F. Rigid abdomen
A, D, E.
