4.If bleeding is more profuse client is hospitalized on bed rest with BRP, IV access; labs: Hgb and Hct, urinalysis,blood group and type and cross match for 2 units of blood hold, possible transfusions; goal is to maintain thepregnancy fetal maturity.5.No vaginal exams are performed except under special conditions requiring a double set-up for immediatecesarean birth should hemorrhage result.6.Low lying or marginal previas may allowed to deliver vaginally if the fetal head acts as tamponade to preventhemorrhage.7.Cesarean birth, often with vertical uterine incision, is used for total placenta previa.8.Steroid shots may be given to help mature the baby's lungs.
Anatomy and PhysiologyNormal Placenta During ChildbirthProcess of placental growth and uterine wall changes during pregnancy
1.The placenta grows with the placental site during pregnancy.2.During pregnancy and early labor the area of the placental site probably changes little, even duringuterine contractions.3.The semirigid, noncontractile placenta cannot alter its surface area.
Anatomy of the uterine/placental compartment at the time of birth
1.The cotyledons of the maternal surface of the placenta extend into the decidua basalis, which forms a naturalcleavage plane between the placenta and the uterine wall.2.There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the branches of the uterinearteries that run through the wall of the uterus to the placental area.3.The placental site is usually located on either the anterior or the posterior uterine wall.
The amniotic membranes are adhered to the inner wall of the uterus except where the placenta is located
Possible Nursing Diagnosis
Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation
Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation
Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss
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 andInactivity During Pregnancy