INTRODUCTION

Placing an implant in the lower uterine section with any degree of covering of the

internal cervical canal is known as Placenta Previa, according to Avila and colleagues

(2016). In most cases, it manifests itself in the second trimester of pregnancy as non-

painful bleeding.

During pregnancy, the placenta moves in response to the womb's stretching and

expanding. Early in pregnancy, it is fairly typical for the placenta to be located at a low

point in the womb. However, as the pregnancy progresses, the placenta begins to

ascend to the top of the womb. By the third trimester, the placenta should be close to

the top of the womb, allowing the cervix to be opened for birth to take place. In some

cases, the placenta partially or fully covers the cervix during pregnancy. This is referred

to as a Previa.

Placing the placenta over the cervix is known as Placenta Previa, in which the

placenta prevents the infant from being born. Pregnancy and childbirth can be severely

affected by it. Women with Placenta Previa are more likely to give birth early, before 37

weeks of pregnancy, than women without it. During pregnancy, an organ called the

placenta develops within the uterine lining. Oxygen and nutrients are carried from the

mother to the unborn kid via the umbilical cord, which is connected to it. Also, it helps to

keep toxins away from the child. Pregnancy can be complicated when the placenta

partially or fully obstructs the uterine cervix, the opening to the womb. To deliver the

baby naturally, the pregnant woman should opt for a vaginal delivery. The placenta

normally attaches at the top of the uterus, away from the cervix, as is the case in most

cases.

1
 Ultrasound is a prenatal test that uses sound waves to create an image of the

baby in the womb. It can typically detect Placenta Previa and determine the position of

the placenta in most cases. Transvaginal ultrasound or Trans labial ultrasound are two

types of ultrasounds that can be performed through the birth canal or through the lips

instead of through the mouth. Three-dimensional ultrasound may be employed in some

situations where it is accessible. When there is no vaginal bleeding, a regular second

trimester ultrasound may reveal Placenta Previa, even without any symptoms. When a

Placenta Previa is discovered in the second trimester, it is necessary to have follow-up

ultrasounds to ensure that the cervix is not blocked any longer. If the placenta is no

longer blocking the cervical opening, the pregnant woman will most likely be able to

deliver her baby through the vaginal route.

In accordance with Silver (2015), in the second half of pregnancy, vaginal

bleeding is often related with placental abnormalities such as Placenta Previa, Placenta

Accreta, and Vasa Previa, to name a few. They are also significant contributors to

severe fetal and maternal morbidity and mortality, as well as infant mortality. The

incidence of Previa and Accreta are also growing, which is most likely because of the

rising rates of cesarean delivery, maternal age, and the use of assisted reproductive

technology. The widespread use of obstetric ultrasonography, as well as the

advancement of ultrasound technology, allows for the early detection of many problems

throughout pregnancy. As a result, accurate antenatal diagnosis makes it easier to

provide effective obstetric care.

In the presented case scenario, the patient had intermittent prenatal care

starting at 12 weeks estimated gestational age. The medical records reveal that the

2
patient is pregnant with a singleton in the vertex position. In terms of medical history,

the patient has no allergies and only takes prenatal vitamins. There is no doubt that the

patient smokes fewer than one half-pack of cigarettes a day. Aside from occasional

bleeding in the previous six weeks, the patient’s pregnancy has been easy, and her

prenatal labs are negative. There is a fetal monitor in place outside of the womb.

The students conducted the case study to learn more about Placenta Previa and

learn how it has affected the lives of people who have been diagnosed with it. The

information gathered from this study would be beneficial to student nurses as this will

expand their understanding about the case, Placenta Previa.

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GENERAL OBJECTIVE:

At the end of the 2-week rotation, the student nurses will gain deeper

understanding of the concepts with regards to the Placenta Previa.

SPECIFIC OBJECTIVES:

Specifically, the student nurses will be able to:

1. present an overview of placenta previa and determine the objectives of the

study;

2. establish baseline data from the patient;

3. analyze the developmental task according to the age of the patient;

4. describe the anatomy and physiology of the systems affected by the disease;

5. explore the different etiological factors that causes placenta previa;

6. discuss the symptomatology of the disorder;

7. explain the pathophysiology of placenta previa;

8. identify and describe the drugs applicable to the patient by formulating a drug

study;

9. identify the laboratory and diagnostic tests that can be performed for the

patient with its implication;

10. formulate nursing care plan appropriate for the patient’s case;

11. explain the nursing implication of the case study in relation to the nursing

practice, education and research;

12. discuss nursing theories in relation to case study presented; and

4
 13. present the case.

PATIENT’S PROFILE

BIOGRAPHIC DATA

Patient’s Name: Patient X

Age: 21 years old

Sex: Female

Birthday: January 22, 2001

Address: Población, Kidapawan City

Place of Birth: Kidapawan City

Civil Status: Single

Nationality: Filipino

Religion: Roman Catholic

Educational Attainment: College Undergraduate

Occupation: Student

MEDICAL DATA:

Chief Complaint: Bright Red Spotting

Date and Time of Admission: February 6, 2022 @8:00 AM

Hospital: ABCD Hospital

Ward: OB Ward

Room and Bed No: Room 107

Tentative Diagnosis: Painless Vaginal bleeding

Final Diagnosis: Placenta Previa

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 Admitting Physician: Dr. Lennie Santos

Admitting NOD: MARIA DELA CRUZ, RN

Attending Physician: Dr. Ferdinand Marcos

OBSTETRIC HISTORY

Obstetric Score: G1P0 (0000) 33 weeks AOG

LMP: March 7, 2021

EDC: April 20, 2022

AOG: 33 weeks 4 days

Immunization: Tetanus doses

Blood type: O

RH: +

HbSag: (-)

MENSTRUAL HISTORY

Menarche: 14 years old

Past cycle: -28 days

-3-4 days of flow

-2-3 pads/day

-No History of dysmenorrhea, passage

of clots

6
I. PAST HEALTH HISTORY

Aside from prenatal vitamins, the patient’s past medical history is

uncomplicated; the patient does not have any allergies and does not use any

medications. The patient admits to smoking fewer than one-half pack of

cigarettes every day.

II. PRESENT HEALTH HISTORY

Although the patient’s prenatal labs were negative, the patient had a

straightforward pregnancy apart from intermittent spotting in the last six

weeks. An external fetal monitor is now in place.

III. HISTORY OF PRESENT PREGNANCY

First Trimester

 Pregnancy was confirmed after 1 ½ months of missed period by a positive urine

pregnancy test (UPT).

 Regular antenatal check-ups

 Booster dose tetanus toxoid vaccine taken

 Folic acids tablets were taken

 No H/o hyperemesis gravidarum or excessive vomiting

 No H/o spotting or bleeding

 No H/o pain abdomen

 No H/o exposure to radiation and drug intake

7
Second Trimester

 Quickening was felt at 5 months gestation

 Second Trimester (Anomaly Scan) was done, and no anomalies were

found.

 Iron and calcium tablets were taken.

 No H/o fever with rashes

 No H/o any drug intake or radiation exposure

 No H/o of vaginal bleeding

 No H/o pedal edema or headache

 No H/o raised blood pressure recording or raised blood sugar recording.

Third Trimester

 Fetal movements are well perceived

 Weight gain in pregnancy: 7 kgs.

 Iron and calcium tablets were taken

 Vaginal bleeding and cramping were felt

FAMILY HISTORY

 No history of bleeding disorder in the family.

 No history children with chromosomal anomaly or birth defects.

 No history of cancer in the family or any gynecological related carcinomas.

 No history of hypertension and diabetes in the family.

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 HEALTH ASSESSMENT

GENERAL SURVEY

 Upon admission, the patient was accompanied by her mother, and she is

wearing loose pajamas and slippers. As she was sitting in the waiting room,

she looked very weak, and pale. The patient has a fair complexion irritable

and out of focus.

CLINICAL MEASUREMENT

ACTUAL RESULT NORMAL RANGE INDICATION

Blood
80/70mmHg 90/60-120/80 mmHg Hypotensive
pressure

Temperature 36.1 C 36- 37.5 C Normal

Pulse rate 110 bpm 60- 100 bpm Tachypnea

Respiratory
10 cpm 12- 20 cpm Bradycardia
rate

Height 150 cm --------------

Weight 59 kg -------------- Pre-pregnancy

weight: 42 kgs;
gained 17 kgs in
twin gestation.

The National
Academy of
Medicine (2019)
indicates this as

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 normal.

Body Mass
26.22 kg/ m2 18.5-24.9 Healthy Weight
Index

FHT 100 bpm 120- 160 bpm Fetal Bradycardia

Fundic 33 cm
32 cm Normal
Height (33 weeks AOG)

Cephalic
Fetal Position Cephalic Normal
(Ideal Position)

Skin

 The patient has a fair complexion. No rashes, and no jaundice. No body

malaise. However, as the forefingers are pressed, capillary refill activity

return to normal color in more than 4 seconds. Patient is presenting pallor,

clammy and cold skin upon inspection.

Head

 The head is normocephalic.

 No presence of dandruff and lice and has a healthy long black hair.

Eyes

 Presence of pink palpebral conjunctiva and no eye discharge.

 Not wearing any eye-support such as reading glasses

 Has 20/20 eye vision.

Nose

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  Upon inspection, the nose had no discharges. No cough and colds.

Breast

 Breasts are symmetric, no dimpling and discoloration noted, nipples and

areolas are dark in color.

Respiratory

 The patient’s respiratory rate is 16 bpm which is normal with no chest pain,

no dyspnea, no cough, and colds were noted, no respiratory distress. As

auscultation the lungs had clear breath sounds.

Cardiovascular

 The patient has an increased pulse rate 120 bpm. Patient is tachycardic.

Gastrointestinal

 The patient’s abdomen is globular and has a presence of striae gravidarum

and Linea Nigra on the abdomen. The abdomen is soft tender upon

palpation, the abdomen had audible bowel sounds. The fundic height is 33

cm and when Leopold’s maneuver was done, the fetal presentation is vertex

presentation, and the back part of the baby was felt on the right side of the

patient.

Urinary

 The patient had no dysuria and frequency urgency. Her urine output is less

than normal, 20 ml/hr. which shows oliguria.

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Genital

 Patient has painless bright red vaginal bleeding.

Peripheral/ Vascular

 The patient has no edema.

Musculoskeletal

 Extremities have a good range of motion.

 No deformities or injuries noted.

Neurologic

 The patient is confused and irritable.

 No neurological deficits noted.

 Has GCS 15 upon assessment.

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 DEVELOPMENTAL STAGES

Stages Justification
Patient X, a 21-year-old woman, fits
Erik Erikson's Intimacy vs. Isolation
Erik Erikson Intimacy versus.
category because she was able to find
Isolation (young adult
a relationship and have a child. This
stage)
stage encompasses the early adult
years when people are figuring out
their personal relationships.
At the age of 21, Patient X belongs to
the Genital (puberty to death) stage
Sigmund Freud where in client would be able to
The Genital Stage
experience expression of sexual
(Puberty to Death)
instinct was through heterosexual
relationships and sexual intercourse
with her partner.
In Jean Piaget's theory of cognitive
development, Patient X belongs to the
formal operational stage because he
was able to undertake logical
Jean Piaget reasoning and systematic planning at
Formal operational
this time. Individuals can ponder
hypothetical and abstract concepts that
they have not yet encountered.
Planning for the future necessitates
abstract thinking.

ERIK ERIKSON

 Erik Erikson maintained that personality develops in a predetermined

order through eight stages of psychosocial development, from infancy to

adulthood. During each stage, the person experiences a psychosocial

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 crisis which could have a positive or negative outcome for personality

development.

SIGMUND FREUD THEORY

 According to Freud, he believed that personality developed through a

series of childhood of stages in which the pleasure-seeking energies of

the id become focused on certain erogenous areas. During the five

psychosexual stages, which are the oral, anal, phallic, latent, and genital

stages, the erogenous zone associated with each stage serves as a

source of pleasure. However, each stage of development is marked by

conflicts that can help build growth or stifle development, depending upon

how they are resolved. If these psychosexual stages are completed

successfully, a healthy personality is the result.

JEAN PIAGET

 According to the theory, Piaget believed that children take an active role in

the learning process, acting much like little scientists as they perform

experiments, make observations, and learn about the world. As kids

interact with the world around them, they continually add new knowledge,

build upon existing knowledge, and adapt previously held ideas to

accommodate new information.

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 ANATOMY AND PHYSIOLOGY OF THE BODY SYSTEMS/AFFECTED BY THE

DISEASE

Female Reproductive System

The female reproductive system produces and sustain the female sex cells (egg

cells or ova), transport these cells to a site where

they may be fertilized by sperm, provide a

favorable environment for the developing fetus,

move the fetus to the outside at the end of the

development period, and produce the female sex

hormones.

Placenta – an organ that develops in the

uterus during pregnancy. This structure provides
oxygen and nutrients to a growing baby and
removes waste products from a baby's blood. The placenta attaches to the wall of the
uterus, and the baby's umbilical cord arises from it.

Cervix – acts as the door to the uterus which sperm can travel through to fertilize
eggs. When pregnant, the cervix helps keep the baby in place until it is fully developed.
The cervical os or internal cervical covering will dilate during labor to allow the baby to
come through the birth canal.

The Female Reproductive System and Placenta Previa

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 Placenta previa is the implantation of the placenta over the opening of the cervix,

in the lower rather than the upper part of the uterus. Normally, the placenta is located in

the upper part of the uterus. In placenta previa, the placenta is located in the lower part

and covers the opening of the cervix. If the placenta is anchored to the bottom of the

uterus, the thinning and spreading separates the placenta and will cause vaginal

bleeding (Victoria, 2021). According to Dulay (2020), it may affect the woman, the fetus,

or both and may occur at different times during the pregnancy. Placenta Previa can

cause severe bleeding during pregnancy and delivery. Mothers with placenta previa are

also at higher risk of delivering prematurely, before 37 weeks of pregnancy

(Cassoobhoy, 2020). As studied by Stoppler (2017), placenta previa can be associated

with other abnormalities of the placenta or of the umbilical cord. A reduction in fetal

growth associated with placenta previa, and the presence of the placenta in the lower

part of the uterus makes breech or abnormal presentation of the fetus more likely.

Moreover, if the placenta partially or totally covers the cervix the woman is at increased

risk of placenta accreta (Mayo Org, et. al, 2021).

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 PATHOPHYSIOLOGY OF THE DISEASE

ETIOLOGY

FACTORS ACTUAL JUSTIFICATION

PREDISPOSING FACTORS
There is a strong association between having a
previous cesarean delivery, spontaneous or
induced abortion, and the subsequent
development of placenta previa. The risk
increases with number of prior cesarean
deliveries. Pregnant women with a history of
Previous cesarean cesarean delivery or abortion must be regarded
section
as high risk for placenta previa. This is due to the
damage and the scar tissue on the lining of the
uterus that is left after a c section procedure (Birth
injury Help Center, 2022). This predisposes to
low implantation of the placenta (Kiondo et al.,
2008). 
Multiple pregnancies are associated with placenta
previa. This is because the large placenta usually
Multiple gestations
encroaches on lower segment of the uterus
(Kiondo et al., 2008). 
Previous placenta Mothers with placenta previa have a tenfold risk
previa
of reoccurrence in a subsequent pregnancy. This

17
 is thought to be linked to defective decidual
vascularization (Kiondo et al., 2008). 
Placenta previa is more common in older and
multiparous women (Eniola et al., 2002). This
may be associated with the ageing of vasculature
Increased maternal of the uterus which causes placental hypertrophy
age
and enlargement then increases the likelihood of
the placenta encroaching on lower segment
(Kiondo et al., 2008).
Women who have given birth to a lot of children
have an increased chance of having placenta
previa. Clark and co-workers noted a seven-fold
increase in previa among women with a parity
Increased parity
greater than five when compared to nulliparous
patients. Studies observed rising risk of placenta
previa with increasing parity may be associated
with (Tuzovic, 2003).

 Asian women have excess risk of placenta previa

compared with white women. Major variation
exists in placenta previa risk among Asian
women, with the lowest risk in Japanese and
Vietnamese women and the highest risk in
Filipino women (Shobeiri & Jenabi, 2017). It is not
Ethnicity
clear why Asian women are more likely than white
women to have pregnancies complicated by
placenta previa. The most common explanations
are socioeconomic status, access to prenatal
care, and prevalence of specific risk factors
(Healy et al., 2006).
PRECIPITATING FACTOR

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  According to a study, cigarette smoking during
pregnancy is a determinant of placenta previa
(Williams et al., 1991). Smoking seems to
increase the risk of previa via a hypoxemia-
related mechanism. Nicotine has a

Smoking vasoconstricting effect on uteroplacental

perfusion in smoking mothers. Placental studies
have demonstrated decreased vascularization
and pronounced changes in the broad basement
membrane of mothers who smoked cigarettes
(Saleh, 2008).

SYMPTOMATOLOGY

SYMPTOMS ACTUAL JUSTIFICATIONS

 Bleeding often occurs as the lower part

of the uterus thins during the third
trimester of pregnancy in preparation for
labor. This causes the area of the
Painless bright red placenta over the cervix to bleed. The
vaginal bleeding
more of the placenta that covers the
cervical os (the opening of the cervix),
the greater the risk for bleeding
(Anderson, 2021). 
Uterine contraction
and bleeding
 This bleeding and uterine contractions
are thought to occur secondary to the
thinning of the lower uterine segment in
preparation for the onset of labor. The
placental attachments become
disrupted or tear with this thinning
process and cervical dilatation (Saju,

19
2001).

20
 Legend:
Predisposing Factors: Precipitating Factors Pathophysiology
PLACENTA PREVIA
 Increasing maternal age  Smoking Mechanism
 Ethnicity
 Previous cesarean section Presence of placental tissue Signs/
 Multiple gestations that extends over the Symptoms/
Laboratory
 Previous placenta previa internal cervical os.
 Increased parity Types of Placenta
Previa
Complications
Total Placenta Previa Partial Placenta Previa Marginal Placenta Previa

Placenta completely Placenta covers Placenta is near the

covers the cervix cervix partially edge of the cervix

Stretching of lower segment of uterus during 3rd trimester

Or
Stretching fails to move the placenta away from the cervical os

The stretching elongates the Previa persists as uterus changes in preparation for labor:
space between the cervix and
the placenta, relocating the
stationary lower edge of the Thinning of the lower Uterine contractions Cervix becomes thinner (effaced) and
placenta away from the segment of the uterus opens (dilates)
cervical os

Shearing forces to Bleeding limits oxygen delivery to placenta,

Placenta previa the placental injuring placental tissues
resolves on its own attachment sites
Tissue injury → activates intracellular G-
Painless bright protein signaling pathways
Reassuring: Placenta red bleeding
>2cm from cervical os Release of stored intracellular calcium
on ultrasound → myometrial contraction
Increasing risk of
clinically significant 21
hemorrhage Uterine contraction and bleeding
Yao & Yu (2022)
 PLACENTA PREVIA

Treatment/Management:
 Maintain bed rest
 No intercourse after 28
weeks of pregnancy
 C-section delivery (if
partial or total)
 Avoid smoking
 Administer prescribed
drugs
 Manage bleeding

If Treated/Managed: If Not Treated/Managed:

 Placenta previa will  Could lead to hemorrhage

resolve on its own  Placenta Accreta
 Normal vaginal  Fetal distress/hypoxia
delivery  Abnormal fetal position
 Premature Labor

22
 Placenta previa is the presence of placental tissue that extends over the internal

cervical os (Lockwood & Stieglitz, 2021). It may be a complete, partial, or marginal

covering of the internal os of the cervix with the placenta and it is a major risk factor for

postpartum hemorrhage and can lead to morbidity and mortality of the mother and

neonate (Bagga & Sze, 2021). As studied by URMCR (2022), the most common

symptom of placenta previa is bright red, painless bleeding from the vagina and it is

most common in the third trimester of pregnancy. As stated by Weiss (2021), placenta

previa can be problematic later in pregnancy, as it may cause severe bleeding, leading

to preterm delivery.

Based on Standford Children’s Health (2022), researchers don't know what

causes placenta previa but there are predisposing factors of increasing maternal age,

ethnicity, previous cesarean section, multiple gestations, previous placenta previa, and

increased parity. There is also a precipitating factor of smoking. Pregnant women with a

history of cesarean delivery or abortion must be regarded as high risk for placenta

previa. This is due to the damage and the scar tissue on the lining of the uterus that is

left after a C-section procedure (Birth injury Help Center, 2022). Multiple pregnancies

are also associated with placenta previa because the large placenta usually encroaches

on lower segment of the uterus (Kiondo et al., 2008). According to a study, cigarette

smoking during pregnancy is a determinant of placenta previa (Williams et al., 1991).

Furthermore, mothers with placenta previa have a tenfold risk of reoccurrence in a

subsequent pregnancy. This is thought to be linked to defective decidual vascularization

(Kiondo et al., 2008). Placenta previa is also more common in older and multiparous

women (Eniola et al., 2002). Clark and co-workers (2021) noted that increase in previa

23
among women with a parity greater than five when compared to nulliparous patients,

and nearly all papers mention the rising risk of placenta previa with increasing parity.

According to the diagram of Yao & Yu (2022), all the predisposing and

precipitating risk factors will lead to placenta previa which the presence of the placental

tissue extends over the internal cervical os. Normally, the placenta should be at the top

of the uterus but with placenta previa, the placenta is positioned on the lower segment

of the uterus and can cover the cervical opening. As said by Cedars Sinai (2020), there

are three types of placenta previa which are total placenta previa, partial placenta

previa, and marginal placenta previa. Complete placenta previa occurs when the

placenta completely covers the opening from the womb to the cervix, while partial

placenta previa occurs when the placenta partially covers the cervical opening, and the

marginal placenta previa occurs when the placenta is located adjacent to, but not

covering, the cervical opening (Stoppler, 2017).

Placenta previa is diagnosed through transvaginal ultrasound, either during a

routine prenatal appointment or after an episode of vaginal bleeding. Most cases of

placenta previa are diagnosed during a second trimester ultrasound exam. When

diagnosed early in pregnancy on routine abdominal ultrasound at 18-20 weeks,

stretching of lower segment of uterus will occur or can be seen during 3 rd trimester.

Placenta previa might resolve on its own because the stretching elongates the space

between the cervix and the placenta, relocating the stationary lower edge of the

placenta away from the cervical os. As stated by Riley & Schwarz (2009), more than 90

percent of the time, placenta previa diagnosed in the second trimester corrects itself by

term. According to Milbrand (2013), the majority of placenta previa will resolve on its

24
own, as the uterus grows, it pulls up the placenta, and the positioning becomes normal

by 20 weeks. But after 20 weeks, if a placenta previa is still present, typically women will

have ultrasounds every 2 to 4 weeks to monitor the previa, as some will still resolve

later. This will then result to a placenta more than 2 centimeters from cervical os on

ultrasound.

Somehow placenta previa might also persists as uterus changes in preparation

for labor. This is because the stretching fails to move the placenta away from the

cervical os. According to Mariz (2021), by the third trimester, the placenta should be

near the top of the womb but if the placenta attaches instead to the lower part of the

uterus, it can cover part or all of the internal opening of the cervix. This will then result to

the sign of painless bright red vaginal bleeding. Based from Mayo Clinic Organization

(2021), bright red vaginal bleeding without pain during the second half of pregnancy is

the main sign of placenta previa. As said by Anderson (2021), bleeding occurs as the

lower part of the uterus thins during the pregnancy in preparation for labor. This causes

the area of the placenta over the cervix to bleed. The more of the placenta that covers

the cervical os, the greater the risk for bleeding. Moreover, if the placenta is anchored to

the bottom of the uterus, the thinning and spreading separates the placenta and will

cause the bleeding (Victoria, 2021).

Aside from painless bright red vaginal bleeding, there can also be a sign of

uterine contraction and bleeding which is caused by the forced shearing of the placental

attachment sites. As said by Lockwood, et. al, (2021), in such patients, uterine

contractions may mechanically promote placental separation and bleeding. This

bleeding is thought to occur secondary to the thinning of the lower uterine segment in

25
preparation for the onset of labor. The placental attachments become disrupted or tear

with this thinning process and cervical dilatation (Saju, 2001).

Placenta previa could also lead to a complication of increased risk of

hemorrhage. Based from CH Philadelphia (2021), the greatest risk of placenta previa is

bleeding or hemorrhage. Bleeding often occurs as the lower part of the uterus thins

during the third trimester of pregnancy in preparation for labor. This causes the area of

the placenta over the cervix to bleed. The more of the placenta that covers the cervical

os, the greater the risk for bleeding. As added from Better Health Channel (2021),

placenta previa can also lead to possible complications of fetal distress from lack of

oxygen, and premature labor or delivery. Moreover, if the placenta partially or totally

covers the cervix the woman is at increased risk of placenta accreta (Mayo Org, et. al,

2021). As said by Wax et. al, (2013), in the setting of a placenta previa and one or more

previous cesarean deliveries, the risk of placenta accreta spectrum is increased.

If placenta previa will not resolve on its own, there are treatments or

management that can be done which are maintaining bed rest, no intercourse during

the pregnancy, C-section delivery (only if partial or total placenta previa), administer

prescribed drugs like corticosteroids, avoid smoking, and manage bleeding. If the

placenta previa will be treated or managed, there are instances that the placenta will

resolve on its own and the woman can have normal vaginal delivery. If the placenta

previa is not treated or managed, it could lead to hemorrhage, placenta accreta, fetal

distress/hypoxia, abnormal fetal position, and premature labor.

26
 LABORATORY RESULTS

NORMAL
EXAMINATION PURPOSE RESULTS NURSING MANAGEMENT
VALUES
An ultrasound scan The placenta can The placenta Assess fetal heart sounds so the
uses high-frequency be found on the partially covers mother would be aware of the
sound waves to top or side of the the mother's health of her baby.
make an image of a uterus. cervix opening.
person's internal
placenta will Assess any bleeding or spotting
body structures.
attach to the front that might occur in the placenta
Doctors commonly (Placenta
of the stomach, to give adequate measures.
ULTRASOUND use ultrasound to previa)
(anterior placenta).
study a developing
Educate the patient about
fetus (unborn baby), placenta attaches
physiological and psychological
a person's to the back of the
changes during pregnancy
abdominal and uterus, near the
pelvic organs, spine, (posterior
muscles and placenta.) Carry out the results of the
tendons, or their altrasound and explain to the
heart and blood patient
vessels.

Encourage the patient to have

bed rest as much as possible.

Answer the mother’s questions

honestly to establish a trusting
environment.

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 DIAGNOSTIC TESTS

Examination Purpose Normal Values Results Nursing Management

Identify and M: 0.42-0.50 99.05  Instruct the patient to w
evaluate the her hands first before
F: 0.36-0.45 0.36
severity of anemia procedure to prev
(low RBCs, low infection.
hemoglobin, low  Asses the function sites
hematocrit) or prevent harm for the pat
polycythemia (high if the puncture site ha
Hematocrit RBCs, high wound.
hemoglobin, high  Encourage the patient to
Test
hematocrit) foods that are high
Monitor the protein and iron, such
response to liver, egg yolk, beef,
treatment of dried fruits such as pru
anemia or and apricots to help
polycythemia and bone marrow prod
other disorders additional red blood cells
that affect RBC  Explain test results to
production or patient and educate
lifespan. patient regarding
importance of eating
healthy food to prev
blood clots.

28
 A urinalysis is a Color: Yellow Yellow  Instruct the patient to v
test of urine. It is (light/pale to every 4 hours to prev
used to detect and dark/deep any infection occur in
manage a wide amber) urine. and watch out for
range of disorders, input and output
such as urinary  Allow the patient to h
Clear
tract infections, Clarity/turbidity: bed rest to avoid so
kidney disease Clear or cloudy stressors that might affe
and diabetes. It her health and her baby.
4.7
also involves  Encourage the patient
Urinalysis pH: 4.5-8
checking the drink plenty of water.
appearance, 180 mg  Explain to the patient ab
concentration and the results of diagnostic
Protein: less
content of urine. to provide adequ
than 150mg/day
Abnormal understanding about

urinalysis results condition.

Bacteria: None None
may point to a
disease or illness. Yeast: None None

This test finds out O - Positive B - POSITIVE  Assess the puncture s

your blood type (A, and clean the skin of
O - Negative Has B Antigen
B, AB, or O) and patient before the test w
meaning. Your
checks your Rh A - Positive an antiseptic to help prev
plasma has
factor. Rh factor is A - Negative infection.
antibodies that
a type of protein  A band around the arm
B - Positive attack type A
found on the patients to make the ve
blood.
surface of red B - Negative more visible.
blood cells. If your Type B
Blood Type AB - Positive  After blood typing tell
blood cells have individuals can
patient to wait for the bl
AB - Negative donate blood
this protein, you type. It can be determine
are Rh positive. If to other B
a matter of minutes. This

29
 they don't, you are individuals prevent frustration of
Rh negative. If you and AB client
are Rh negative individuals.  After the patient know
and your unborn results of blood type, adv
baby is Rh the patient that she
positive, your body donate blood and rece
may begin to make transfusions from donor
antibodies against the compatible bl
your baby's blood groups.

A complete blood Red blood cell 770,000ml  Explain the proced

count:
count (CBC) is a Explain that when the ski
Complete
blood test used to 3.92-5.13 trillion punctured, there may
Blood Count cells/L
evaluate your some discomfort.
(3.92-5.13 million
overall health and cells/mcL)  Encourage the patient
detect a wide minimize stress as much
range of disorders, Hemoglobin: possible because a cha
including anemia, 860,00ml in physiologic condition
11.6-15
infection and grams/dL affect and change nor
leukemia. A (116-150 hematologic readings.
grams/L)
complete blood  Explain the results of
count test test to the patient for
measures several White blood cell better understanding.
count:
components and 10,200ml  An eye out for leaking
(3,400 to 9,600
features of your cells/mcL) hematoma formation at
blood, including puncture site.
Red blood cells,
Platelet count:
which carry
Female: 157-371 700,000mc
oxygen. billion/L
(157,000 to
371,000/mcL
Human Positive: quality The results  Explain the procedure to

30
 immunodeficiency control line (C). show the patient for be
virus (HIV) testing Testing line (T) patient is understanding of the pat
about the Procedure
determines both produce a negative for
also encourage cooperat
whether you're red line. HIV  If you are getting a blo
infected with HIV, Make sure the puncture
Human Negative: Only Negative: is clean with an antise
Immunodefic a virus that
quality control Only quality wipe.
ency Virus weakens your
line (c) produces control line (c)  Drawn a blood into a
(Hiv) immune system glass tube called a pipe
a red line but produces a
and can lead to which is then placed i
Testing line (T) red line but reagent called a buffer.
acquired buffer and two o
produce nothing. Testing line
immunodeficiency chemicals (a dying ag
(T) produce
syndrome (AIDS). Invalid: Control and clearing solution)
nothing. poured into a plastic
line (C) produce
called a membrane.
nothing, it means
 Explain to the patient a
the operations is 15–20 minutes,
wrong. membrane is checked. If
membrane has one dot
the bottom, the test
nonreactive (negative).
the membrane has two d
the test is reac
(preliminary positive).
- A confirmatory blood tes
then performed. Explain
the patient the results
are available a few d
later.

31
 SURGICAL MANAGEMENT

SURGICAL INDICATION RESULT NURSING MANAGEMENT

PROCEDURE
Once the baby is old Cesarean baby  The baby may need to be
enough to be boy was delivered monitored in neonatal intensive
delivered, a caesarean at 2 pm with care unit.
CESAREAN section is usually APGAR score ≤7
SECTION performed (Better prematurity (< 37 
DELIVERY health, 2014). weeks), low birth  Anticipate the need of
weight (< 2500 g), transfusion and secure a
Doctors always do a compatible blood type to that of
C-section when there the mother.
is a placenta previa at While the mother is
the time of delivery. A under monitoring  Monitor VS religiously and note
vaginal delivery could due to heavy any unusuality and report
disturb the placenta bleeding more than immediately to the physician.
and cause severe 500ml
bleeding (Michigan  Assess baseline data and note
Medicine, 2022). changes and monitor FHR and
report to physician

 Document the care and

procedure done.

32
MEDICATI- MODE OF ACTION DOSAGE INDICATIO- CONTRAINDICATI-
DRUG STUDY SIDE ADVERSE NURSING
ON N ON EFFECTS EFFECTS RESPONSIBILI-
TIES
Brand Classifications: 4 to 6 g  decreasi  Heart block  heart Significant:   Monitor vital
Name: Sulfate intravenousl ng  myocardial disturbanc Hypermagnesemi signs, deep
MgSO4 y with a uterine damage es, a. tendon
Mechanism of action: maintenanc tonus  hepatic  breathing Gastrointestinal reflexes,
Generic magnesium sulfate is e dose of 1 preventi encephalopat difficulties, disorders:  magnesium
thought to trigger to 3 g/hr ng hy  poor Gastrointestinal concentratio
Name:
cerebral vasodilation, prematur  hepatic failure reflexes, discomfort, ns if frequent
Magnesiu thus reducing ischemia
e birth renal failure  confusion, diarrhea. or prolonged
m Sulfate generated by cerebral Metabolism and dosing, renal
Drug  sweating,
vasospasm during an  lowered nutrition function,
eclamptic event blood disorders:  ECG
pressure, - Hypocalcemia monitoring
- hypophosphatemia
 feeling like
-hypertonic  Obstetrics:
you might
dehydration Monitor
pass out,
Potentially Fatal: patient
 anxiety,
-Magnesium status, vital
 cold toxicity leading to signs,
feeling, CV arrest and/or oxygen
 extreme respiratory saturation,
drowsines paralysis respiration,
s, (parenteral) deep tendon
 muscle reflexes,
tightness level of
or consciousne
contractio ss, fetal
n, or heart rate,
 headache maternal
uterine
activity, renal
function.

 Monitor

33
 magnesium
concentratio
ns every 4
hours in
patients with
renal
dysfunction.
Brand Classification: Iron 65-200 mg Ferrous Haemochromato  Constipati Gastrointestinal Monitor Hb
Name: Products  daily PO Sulfate is sis, other iron on. disorders:  and
Slow FE, indicated overload  Contact Gastrointestinal hematocrit:
Fer-In-Sol, Mechanism of action: in the syndromes. irritation. irritation, nausea, RBC count
Feratab, treatment  Diarrhea. vomiting, and indices,
Iron, Mol- Ferrous and  Dark epigastric pain, serum ferritin,
Iron, sulfate replaces iron st prevention stools. diarrhea, transferrin
Feosol, ores found in of iron  Gastrointe constipation, saturation,
MyKidz hemoglobin in red deficiency stinal (GI) blackening of total iron-
Iron 10 blood cells, myoglobin, anemia hemorrha stool, tooth binding
and other heme and ge (rare) discoloration, capacity,
Generic enzymes in the body anemia of  Gastrointe abdominal serum iron
Name: pregnancy stinal (GI) discomfort concentration
Ferrous where irritation. and
Sulfate routine Immune system erythrocyte
 Gastrointe
Drug administra disorders:  protoporphyrin
stinal (GI)
tion of iron Hypersensitivity concentration.
obstructio
is
n (wax
necessary
matrix
.
products;
rare)
 Gastrointe
stinal (GI)
perforation
(rare)

34
GENERIC Classifications: opioid -2 mg IV - indicated - Patients nausea, somnolence, use caution
NAME: agonist-antagonists shortly for the hypersensitive to vomiting, dizziness, with
BUTORPH before managem butorphanol drowsiness, nausea, and concurrent
ANOL induction ent of pain tartrate or the dizziness, vomiting. use of MAOIs
TARTRAT Mode of Action: and/or 0.5 when the preservative dry mouth, may cause
E The exact mechanism to 1.0 mg IV use of an benzethonium and confusion,
of action is unknown, in opioid chloride. warmth or hallucinations,
BRAND but is believed to increments analgesic redness sedation
NAME: interact with an opiate during is under the monitor for
Stadol receptor site in the anesthesia appropriat skin CNS
CNS (probably in or e. depression
associated with assess blood
pressure pulse
and
respirations
during
administration
administer
slowly through
IV line
Brand Classifications: 12–12.5 mg Reduce Diabetes stomach Burning, itching, Explain the
name:  Corticosteroids IM initially; inflammati pain and irritation at purpose of the
may be on of the Tuberculosis the injection site; drug to the
Celestone Mode of action: repeated in skin indigestion swelling, client
Soluspan Betamethasone is a 24 hours and/or Psychiatric tachycardia, • Administer
corticosteroid that acts and again in bronchial disease rise in headache, the initial dose
Generic
name: as an anti-inflammatory 1 to 2 tubes appetite dizziness, weight IM. Anticipate
and weeks gain, sodium and the need for
Betametha immunosuppressive Speed rise in blood fluid retention; repeat dosing
sone agent. It is given to lung sugar levels increased risk of within 24 hours
and again in 1
pregnant women 12 to developm infection if used
to 2 weeks
24 hours before birth to ent if fluid build long term
• Assist with
hasten fetal lung premature up measures to
maturity if a fetus is birth is at halt preterm
less than 34 weeks’ risk mood labor if
gestation and help changes indicated

35
prevent respiratory • Continue to
distress syndrome in monitor client’s
the newborn vital signs and
(Karch, 2009). fetal heart rate
for changes
• If client is
Pregnancy Risk also receiving
Category: C a tocolytic
agent, be alert
for possible
cardiac
decompensatio
n because of a
drug–drug
interaction.
Observe for
signs such as
increased
pulse,
decreased
blood pressure,
and presence
of edema
• Assess for
signs and
symptoms of
possible
infection with
long-term use
• Instruct client
about the
possibility that
a repeat dose
may be
necessary.

36
 NURSING CARE PLANS
NURSING MASLOW’S OBJECTIVES OF NURSING
ASSESSMENT DIAGNOSIS WITH HIERARCHY CARE INTERVENTIONS WITH EVALUATION
RATIONALE OF NEEDS RATIONALE
SUBJECTIVE: Deficient Fluid Physiological At the end of 8 Temperature, skin color, -After administering
Volume r/t Active Needs hours of nursing and moisture. nursing interventions,
-Expresses feeling Blood Loss intervention: Rationale: the goal was met.
thirsty Secondary to Although fever, chills, and
Disrupted Placental -The patient can diaphoresis are common -The patient identified
-Verbalizes Implantation identify with signs/symptoms such
feelings of signs/symptoms infectious process, fever as decreased urine
weakness such as decreased with flushed, dry skin may output, pale, cold,
Rationale: urine output, pale, reflect dehydration. clammy skin, etc. that
-States feeling Is a state or condition cold, clammy skin, requires medical
dizzy/lightheaded, where the fluid output etc. that requires Monitor intake and output evaluation.
especially when exceeds the fluid medical evaluation. (I&O); note urine- specific
changing position intake. It occurs when gravity.
the body loses both -The patient
-The patient will Rationale: independently performs
water and electrolytes Provides ongoing estimate
independently necessary procedures
from the ECF in
OBJECTIVE: perform necessary of volume replacement
correctly such as
similar proportions. needs,
procedures bedrest and taking
Common sources of
-Patient is 21 y.o fluid loss are the correctly such as kidney function, and
medications.
gravida 2 bedrest and taking effectiveness of therapy.
gastrointestinal tract, medications like -Patient verbalizes
polyuria, and
-Decreased urine magnesium sulfate. Weigh daily. understanding of
increased Rationale:
output of 20ml
perspiration. -Patient will Provides the best disease process and
(less than
Reference: verbalize assessment of current fluid appropriate treatment
30ml/hour) plan.
Ackley, B. J., Ladwig, understanding of status and
-Weakness G. B., Msn, R. N., disease process adequacy of fluid
-Patient initiates
Makic, M. B. F., and appropriate replacement.
lifestyle/behavior
Martinez-Kratz, M., & treatment plan. changes such as
Zanotti, M. (2019).

37
Nursing Diagnosis having a healthy diet,
Handbook E-Book: Assess patient’s knowledge learning stress
An Evidence-Based -Patient initiates of the disease process. management,
Guide to Planning lifestyle/behavior Provide information about performing exercise
Care. Mosby. changes such as pathophysiology of PIH, and physical activities,
having a healthy implications for mother and and taking and taking
diet, learning stress fetus; and the rationale for antioxidants.
management, interventions, procedures,
performing exercise and tests, as needed.
and physical Rationale:
activities, and Establishes data base and
taking antioxidants. provides information.
Provide information about
areas in which learning is
needed. Taking information
can improve understanding
and reduce fear, helping to
facilitate the treatment plan
for the client.

Provide information about

signs/symptoms indicating
worsening of condition and
instruct patient when to
notify healthcare provider.
Rationale:
Helps ensure that patient
seeks timely treatment and
may prevent worsening of
decreasing urine output or
additional complications.

Have patient informed of

health status, results of

38
 when tests, and fetal well-
being.
Rationale:
Fears and anxieties can be
compounded when
patient/couple does not
have adequate information
about the state of the
disease process or its
impact on patient and fetus.

Educate and assist family

members in learning the
procedure for home
monitoring of BP, as
indicated.
Rationale:
Encourages cooperation in
treatment regimen, allows
immediate intervention as
needed, and may provide
reassurance that efforts are
beneficial.

Review techniques for

stress management and diet
restriction.
Rationale:
Strengthens importance of
patient’s responsibility in
treatment.

ASSESSMENT NURSING OBJECTIVES OF NURSING RATIONALE EVALUATIO

DIAGNOSIS CARE INTERVENTIONS
39
SUBJECTIVE Fear related to At the end of - Open about your - This approach After admin
CUES: threat of death of administering awareness of the validates the feelings nursing interve
the fetus possibly nursing patient’s fear. the patient is holding the goals were m
The patient evidenced by intervention: - Discuss the situation and demonstrates
verbalizes that she verbalization of with the patient and help recognition of those - Client discusse
panicked when specific concerns - Client will discuss differentiate between real feelings. regarding self,
she had and increased fears regarding self, and imagined threats to and future pregn
intermittent tension fetus, and well-being. - This approach recognizing
spotting. "Maam future pregnancies, - Tell patient that fear is a helps the patient deal versus unhealthy
sobrang iyong recognizing healthy normal and appropriate with fear.
takot ko ng nakita versus unhealthy response to - This reassurance - Client ver
ko iyong dugo, fears. circumstances in which places fear within the accurate knowle
tingin ko nakunan pain, danger, or loss of field of normal the situation.
ako" - Client will control is anticipated or human experiences.
verbalize accurate felt - The physical -Client demon
OBJECTIVE knowledge of the - Be with the patient to connection with a problem-solving
CUES: situation. promote safety especially trusted person helps use res
during frightening the patient feel effectively.
 Increased - Client
demonstrate
will procedures or treatment secure and
during a period of -
safe
pulse rate: - Initiate alternative
problem-solving treatments. fear. reported/displaye
110 bpm and use resources - Provide verbal and - Meditation, prayer, lessened fear
 Respirator effectively. nonverbal (touch and hug music, Therapeutic fear behaviors.
y rate: with permission) Touch, and healing
10 bpm - Client will reassurances of safety if touch techniques
report/display
 Low Blood lessened fear
safety is within control. help lighten fear.
Pressure: and/or fear
80/70 behaviors.
mmHg
 Pallor
 Increased
40
 perspiration

NURSING MASLOW’S
OBJECTIVES NURSING
ASSESSMENT DIAGNOSIS WITH HIERARCHY RATIONALE EVALUATION
OF CARE INTERVENTION
RATIONALE OF NEEDS

Ineffective Tissue Safety Needs At the end of 8 1. Assess for 1.Clusters of At the end of 8
SUBJECTIVE: perfusion r/t Rationale: hours span of signs of signs and hours span of
The patient blood loss as This case nursing decreased tissue symptoms occur nursing
verbalized, “Ma`am evidenced by belongs to intervention: perfusion. with differing
intervention: Goals
sobrang lakas po ng vaginal Maslow’s causes.
pagdurugo ko at bleeding Hierarchy of 1. Patient Evaluation of were met.
parang Rationale: Needs verbalizes or Ineffective
nagmamanhid po The body can't categorized demonstrates Tissue Perfusion 1. Patient
ang aking katawan” function without into safety normal defining verbalized and
oxygen, so needs. sensations characteristics demonstrated
obviously this is a Because the and provides a normal sensations
problem. When client was movement as baseline for and movement as
tissues don't dependent on appropriate. future appropriate.
OBJECTIVE: receive enough the health care comparison.
Maternal Uterine oxygen through providers about 2. Patient
2. Patient will 2. Assess
Activity: the capillaries, this her situation 2. Any invasive demonstrated no
demonstrate patient’s vital
• Frequency: is called ineffective procedure such further
no furthersigns and
gradually tissue perfusion. as surgery can deterioration
deterioration perform a
increases to a rate Many conditions put patient at risk
focused physical
of one contraction can disrupt the 3.Patient for bleeding. 3.Patient engaged
assessment,
every two minutes exchange of engages in looking for any in behaviors or
• Duration: gradually oxygen and behaviors or signs actions to improve
of
increases to 60 carbon dioxide, but actions to bleeding. tissue perfusion.
seconds diabetes, obesity, improve tissue
• Intensity: gradually anemia, high blood perfusion. 3. Maintain bed 3. Gently

41
increasing to 100 pressure, and rest and promote repositioning 4. Patient
mm Hg coronary artery a quiet and patient from a maintained vital
disease are some 4. Patient relaxing supine to signs in normal
of the more maintain vital environment. sitting/standing
signs in range and
common risk position can
factors that can normal range reduce the risk demonstrated no
cause ineffective and for orthostatic BP signs of bleeding
tissue perfusion. demonstrate changes.
We can further no signs of 4. Assess 4. An abnormal
classify the type of bleeding maternal bleeding episode
ineffective tissue physiological may result in
perfusion based circulatory status pregnancy
on the part of the and blood complications
body affected volume. such as
uteroplacental
hypovolemia or
hypoxia.
5.Monitor and
record maternal 5. Maternal blood
blood loss and loss is harmful to
uterine placental
contractions perfusion. If
uterine
contractions are
accompanied by
cervical
dilatation,
bedrest and
medications may
not be effective
in maintaining
the pregnancy.

42
 DISCHARGE PLAN

MEDICATION

1. Always check the home medications prescribed from the discharge summary to

prevent medication errors and delay of medication administration.

2. Report or notify immediately your physician once there is an allergy or untoward

drug reactions.

3. Discuss the importance of compliance to medications and other treatment.

4. Take your medicine as directed. Once unfamiliar feelings in the body are felt

and noticed, it is highly recommended to contact a healthcare unit or facility.

EXERCISE

1. Instruct patient to do light physical activity such as walking.

2. Avoid heavy lifting type of exercise.

TREATMENT

1. The patient must be able to understand and comprehend the following

diagnostic procedures and treatments regarding Placenta Previa.

2. The patient must adhere to treatment regimen given by her physician.

3. The patient must see her physician regularly.

4. Advice the patient for adequate bed rest for her recovery.

HYGIENE

1. Implement perineal wash to prevent infections and promote wound healing.

2. Educate the patient about proper hand washing and hand hygiene.

3. Wipes genitals from front to back.

43
 4. Instruct the patient to take daily bath.

OUTPATIENT CHECKUPS

1. The patient should attend follow-up check-up for the physician to check the

progress of recovery..

DIET

1. Continue to eat a healthy pregnancy diet.

2. Avoid sweet desserts and unsweetened beverages.

3. Include foods that are high in fiber such as bananas, beans, lentils, nuts, oats,

and other whole grains can help remove harmful bacteria from your body.

4. Advice the patient to eat more protein such as eggs, fish, chicken, and legumes

to help balance the blood sugar level.

5. Drink plenty of water. This helps to rehydrate the blood when the body tries to

remove excess glucose through urine.

44
 RELATED NURSING THEORY

Dorothea Orem Self Care Deficit Theory

Placenta Previa occurs when the placenta covers the opening of the cervix during the

last months of pregnancy. This condition can cause severe bleeding before or during labor. The

placenta develops in a pregnant person’s uterus during pregnancy. This sac-like organ provides

the developing baby with food and oxygen. It also removes waste products from the baby’s

blood. The placenta is also referred to as “afterbirth” because it exits the body after the baby is

born.

During pregnancy, the uterus stretches and grows. It’s normal for the placenta to be low

in the uterus in early pregnancy. As the pregnancy continues and the uterus stretches, the part

of the uterine the placenta was stuck to moves, usually away from the cervical opening. By the

third trimester, the placenta should be near the top of the womb. This position allows the cervix,

or the entrance to the womb at the bottom of the uterus, a clear path for delivery. Most pregnant

people with placenta Previa will require pelvic rest. This typically includes abstaining from

having sexual intercourse, limiting any procedures like an obstetrical check for dilation, and

possibly restricting any exercises that may strain the pelvic floor.

On the other hand, there is a mutual relationship between Placenta Previa and quality of

life. One of the important patterns which is based on individuals’ abilities and their needs for

self-care is Orem Self Care Model. Orem’s self-care model is one of the most complete self-

care theories that provides a good clinical guide for planning and implementing the principles of

good self-care. Orem believes that human beings can take care of themselves and whenever

this ability is distorted in a person, nurses can help individuals to regain this ability by providing

direct care, and compensatory educational supports.

Orem’s approach to the nursing process provides a method to determine the self-care

deficits and then to define the roles of patient or nurse to meet the self-care demands. The

45
steps in the approach are thought of uas the technical component of the nursing process. Orem

emphasizes that the technological component “must be coordinated with interpersonal and

social pressures within nursing situations.

The nursing process in this model has three parts. First is the assessment, which

collects data to determine the problem or concern that needs to be addressed. The next step is

the diagnosis and creation of a nursing care plan. The third and final step of the nursing process

is implementation and evaluation. The nurse sets the health care plan into motion to meet the

goals set by the patient and his or her health care team, and, when finished, evaluate the

nursing care by interpreting the results of the implementation of the plan.

46
 NURSING IMPLICATIONS

Nursing Education

This study helps in enriching the knowledge base of the nurses regarding

the concepts of this kind of complication. The student nurses can teach a various

coping strategies skill that may help the patient, deal more effectively with the

illness and may contribute to an improved outcome for the patient. This can

cater all the questions regarding how and why this certain kind of operation is

performed.

Nursing Practice

This case study would be beneficial in relation to the nursing practice. This

will also help the nursing student to determine the best approach to be delivered

to a particular patient, to render better care to patients, enhance our

understanding. This will also enhance one’s knowledge and understanding

based on the condition and its appropriate intervention for patient and due to the

COVID-19 pandemic we could not handle the patient in physical contact however

if the situation goes back to normal we can apply all the learnings, we can assure

that we will be able to develop, master our skills and ability to learn, think

critically, analyze, assess, apply the nursing process to care the patient, ability to

accept responsibility and accountability.

Nursing Research

As it is a comprehensive compilation, this study greatly helps in the

development of nursing profession. This study is necessary regarding the

47
effectiveness of the nursing intervention. It could help patients improve their life

performance and improving their condition. This guides student nurses in

anticipating the results and in promoting practice changes based on results,

enhance what we have learned now so that we may be able to give better care.

Through this study we hope it gives a chance to expound and add information to

improve management of the condition, patients would receive better care and

developed plans of care.

48
 REVIEW OF RELATED LITERATURE

According to (Anderson-Bagga & Sze, 2021) Placenta previa is the complete or

partial covering of the internal os of the cervix with the placenta. It is a major risk factor

for postpartum hemorrhage and can lead to morbidity and mortality of the mother and

neonate. This situation prevents a safe vaginal delivery and requires the delivery of the

neonate to be via cesarean delivery. Most cases are diagnosed early on in pregnancy

via sonography and others may present to the emergency room with painless vaginal

bleeding in the second or third trimester of pregnancy. The presence of placenta previa

can also increase a woman's risk for placenta accreta spectrum (PAS). This spectrum of

conditions includes placenta accreta, increta, and percreta. This activity reviews the

evaluation and management of patients with placenta previa. It also highlights the role

of an interprofessional team in managing patients with this condition in order to improve

outcomes for mother and fetus.

According to (Rowe, 2014) Few obstetrical conditions have the far-reaching

effects of placenta previa. Pregnancy itself can be an anxious time, but for the most part

the anxiety is restricted to the prospective parents. A woman with placenta previa,

however, will potentially be a source of anxiety for her caregivers and her wider family

circle. Not knowing when the anticipated antepartum hemorrhage might occur in

hospital or at home, close to term or far removed from it is unsettling for most. Beyond

this, not knowing whether the anticipated bleeding will be life-threatening is potentially

unnerving for all but the most seasoned professionals. Placenta previa has an overall

49
prevalence in North America of 2.9 per 1000 pregnancies, compared with a global

prevalence of 5.2 per 1000 pregnancies.

The highest prevalence internationally is in Asian women, in whom the overall

prevalence is 12.2 per 1000 pregnancies. Available data do not allow us to establish

why there are regional differences in these rates, although in 1993 Iyasu et al. found

that in the United States women with Asian ethnicity had twice the risk of placenta

previa compared with women of other ethnicities.

This suggests that there may be a genetic predisposition. The occurrence of

placenta previa is also significantly associated with uterine scarring and endometrial

disturbance that occurs with uterine instrumentation (such as curettage), previous

placenta previa, and, importantly, Caesarean section.

It appears that for reasons yet unknown the presence of scarring or endometrial

disruption in the lower uterine segment predisposes to placental implantation in that

area. Placenta previa is the cause of one-third of cases of vaginal bleeding in the

second and third trimesters. It literally means ‘placenta going ahead’ and involves

implantation of the placenta near or over the internal cervical os. Diagnosis is now

almost always made by ultrasound. The blood that is lost is maternal, except for the rare

cases of vasa previa, where fetal blood is lost, and fetal compromise can be rapid and

catastrophic. Placenta previa may lead to excessive bleeding upon placental

detachment after delivery, as the lower uterine segment is more fibrous and less

muscular than the fundus and thus does not contract as well around the spiral arteries,

the major mechanism that halts uterine bleeding postpartum. Risk factors for placenta

previa include multiparity, previous cesarean section, and uterine anatomic

50
abnormalities. Anesthetic implications of a placenta previa are the necessity for

cesarean section, the potential for increased bleeding, and potentially a longer and

more complicated operation. Bleeding from a simple placenta previa is usually not

catastrophic but can be if the placenta is also a placenta accreta (Smiley, & Herman,

2006). According to (Rumack, 2018) the differentiation of placental position has

historically been performed by digital assessment of the lower uterine segment and

placenta through the cervix. Using this potentially hazardous method of evaluation,

placental position was classified as complete placenta previa, partial placenta previa,

incomplete placenta previa, marginal placenta previa, low-lying placenta, and placenta

distant from the internal cervical os. These classifications do not directly apply to the

ultrasound examination of placental position relative to the cervix. The use of ultrasound

to evaluate the position of the placenta in the uterus has both improved knowledge of

the placenta within the uterus and simplified terminology with respect to placental

position. Complete placenta previa describes the situation in which the internal cervical

os is totally covered by the placenta. Some differentiate those placentas that have a

portion of placental substance that extends over the internal cervical os from those that

are centrally placed over the cervix, a so-called central placenta previa. Marginal

placenta previa denotes placental tissue at the edge of, or encroaching on, the internal

cervical os. Allow placenta is one in which the placental edge is within 2 cm, but not

covering any portion, of the internal cervical os. The terms incomplete placenta previa

and partial placenta previa have no place in the current sonographic assessment of

placental position and should be used only by a clinician performing a digital

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examination when a “double setup” is necessary to determine where the leading edge

of the placenta lies.

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Weiss, R. (2021). What Is Placenta Previa? Complications & Concerns.

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