The maternity nurse is preparing for the admission of patient Corona Angel Covid in her third trimester

of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa.

Placenta Previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower
part of the uterus, is the most common cause of painless bleeding in the third trimester of pregnancy.

It occurs in four degrees:

1. Low-lying Placenta (Implantation in the lower rather than in the upper portion of the uterus)

2. Marginal Implantation (The placenta edge approaches that of the cervical os)

3. Partial Placenta Previa (Implantation that occludes a portion of the cervical os)

4. Total Placenta Previa (Implantation thst totally obstructs the cervical os)

Diagnostic test made to diagnose Placenta Previa: Sonogram

Contrainidicated procedure to client with placenta previa:

1. Never attempt a pelvic or rectal examination

2. Internal monitor for either fetal or urine assessment is contraindicated

Assessment findings:

1. The bleeding is usually abrupt, painless, bright red and sudden enough to frighten a woman.

Nursing Interventions:

1. Inspect the perineum for bleeding and estimate the present rate of blood loss. Weighing perineal
pads before and after use and calculating the difference by subtraction is a good method to determine
vaginal blood loss.

2. Continue to assess BP every 5-15 minutes or continuously with an electronic cuff.

3. Attach external monitoring equipment to record fetal heart sounds and uterine contractions.
4. Monitor urine output frequently, as often as every hour, as an indicator her blood volume is
remaining adequate to perfuse her kidneys

5. Listening to fetal heart sounds and being reassured they are in a healthy range is helpful, as is having
a listening ear she can talk to about her fears for both the pregnancy and herself.

Medical Interventions:

1. An Apt or Kleihauer-Betke test (test trip procedure) can be used to detecr whether the blood is of
fetal or maternal origin.

2. HgB, HCT, prothrombin time, partial thromboplastin time, fibrinogen, platelet count, type and cross-
match, and antibody screen will be assessed to establish baselines, detect a possible clotting disorder,
and ready blood for replacement if necessary.

3. Administer IV fluids as prescribed, preferably with a large-gauge catheter to allow for blood
replacement through the same line.

4. Betamethasone, a steroid that hastens fetal lung maturity, may be prescribed for the mother to
encourage the maturity of fetal lungs if the fetus is less than 34 weeks gestation.

Surgical Interventions:

1. Attempt a careful speculum examination of the vagina and cervix to establish the degree of fetal
engagement in an operating room or a fully equipped birthing room so that if the hemorrhage does
occur with cervical manipulation, an immediate CS birth can be performed.

2. Have oxygen equipment available in case the fetal heart sounds indicate fetal distress.

3. Oversewing the placental implantation site

4. Bilateral uterine artery ligation (O'Leary stitch)

5. Internal iliac artery ligation

6. Circular interrupted ligation around the lower uterine segment both above and below the transverse
incision

7. Packing with gauze or tamponade with the Bakri balloon catheter

8. B-lynch stitch

Risk assoc. With placenta Previa:

1. More prone than normal to postpartum hemorrhage because the placental site is in the lower uterine
segment, which does not contract as efficiently as the upper segment.

2. Endometritis, because the placental site is close to the cervix, the portal of entry for pathogens.

Postpartum care:

1. Check for postpartum hemorrhage

2. Administer Iron as prescribed

Who are at risk to develop placenta previa:

1. Increased Parity

2. Advanced maternal age

3. Past CS births

4. Past uterine curretage

5. Multiple Gestation

6. Male fetus