MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109
PLACENTA PREVIA
DEFINITION
• Abnormal / low implantation of the
placenta
o Nearing the cervical os
• Accounts 20% of pregnancy bleeding
• Painless bleeding
CAUSE
• Unknown
DEGREES
A. LOW-LYING
• The implantation is lower rather than
in the upper portion of the uterus
B. MARGINAL IMPLANTATION
• The placenta edge approaches the
cervical os
C. PARTIAL
• Implantation of the placenta occludes
a portion of the cervical os
D. TOTAL
• Implantation of the placenta totally
occludes of the cervical os
ASSOCIATED FACTORS
1. INCREASED PARITY AND ADVANCED
MATERNAL AGE
• Associated with the aging vasculature
of the uterus that leads to placental
hypertrophy
2. PAST CESAREAN BIRTHS
• Because of uterine scarring d/t surgery
3. PAST UTERINE CURETTAGE
• d/t scarring
4. MULTIPLE PREGNANCY
• d/t a large placenta entering the
uterus
INCIDENCE
• 5:1000 pregnancies
OUTCOME
• Increase in congenital fetal anomalies
o d/t inadequate oxygenation and
nutrition
ASSESSMENT FINDINGS
1. PAINLESS VAGINAL BLEEDING
• Fresh, bright red and sudden
• Third trimester approximately week
30/7th month
2. UTERINE SOFT/FLACCID OR
INTERMITTENT HARDENING
• If in labor
3. INTERMITTENT PAIN
• If it happens in labor secondary to
uterine contractions
4. SLIGHT / PROFUSED BLEEDING
• Which may come after an activity,
coitus or internal examination
ASSESSMENT FINDINGS (BLEEDING)
1. AOG / DURATION OF PREGNANCY
2. TIME OF BLEEDING
3. ESTIMATED BLOOD AMOUNT
4. ACCOMPANYING PAIN
5. BLOOD COLOR
6. INTERVENTION USED FOR BLEEDING
7. PRIOR BLEEDING EPISODES
8. PRIOR CERVICAL SURGERY
9. APT / KLEIHAUER-BETKE TEST
10. WEIGHT OF PERINEAL PADS
• Before and after
• Calculate by subtracting
11. INSPECT FOR BLEEDING & ESTIMATED
RATE OF BLOOD LOSS
• To know how much blood is to be
replaced through BT
LABORATORY TESTS
1. HEMOGLOBIN & HEMOCRIT
2. COAGULATION PROFILE
• Prothrombin time & Partial
prothrombin time
o Use to determine clotting time
o Normal value is 11-13 secs
• Fibrinogen
• Platelet count
3. BLOOD TYPE & RH
4. KLEIHAUER-BETKE TEST
• Detects fetal blood in maternal
circulation
RICCI D. CASTRO / BSN 2
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MATERNAL AND CHILD HEALTH NURSING
LECTURE / NCM 109

DIAGNOSIS COMPLICATIONS
• ULTRASONOGRAPHY A. HEMORRHAGE
o 95% accurate B. PREMATURITY
o Detects site of placental implantation / C. OBSTRUCTION OF BIRTH CANAL
position
o Determines fetal AOG NURSING IMPLEMENTATION
1. Maintain bedrest
o Detects possible malformations
• left lateral recumbent with a head
TREATMENT pillow
A. WATCHFUL WAITING (EXPECTANT 2. Do not perform an IE or vaginal
MANAGEMENT) examination
• Complete bed rest 3. Careful assessment
• No coitus • VS, bleeding, onset/progress of labor,
• No strenous activity FHT
• Keep hydrated 4. Prepare client for diagnostic
B. AMNIOTOMY ultrasonography
• Artificial rupture of the bag of waters 5. Institute shock measures as necessary.
• When AOG is full term Initially, bleeding in previa is rarely life-
• Sped-up descent of fetal head threatening but may become profuse with
C. DOUBLE SET UP internal examination
• One set for vaginal delivery and 6. Provide psycchological and physical
another for classical CS support
• Prepared for IE in suspected placenta 7. Prepare for conservative management,
previa double set-up, or a classical CS
Conditions 8. Observe for bleeding after delivery
• Term gestation • The lower uterine segment, the site of
• Mother in labor and progressing well placental detachement, is not a
contractile as the upper fundal portion
• Mother and fetus are stable
o If the woman is not in labor or in shock, 9. Administer IV fluids, blood products, &
and/or fetus is distressed, only one set-up medications
is to be prepared, an emergency 10. Have oxygen equipment incase of fetal
CLASSICAL cesarean section set up distress
D. DELIVERY
If conditions for watchful waiting are absent
• Vaginal delivery if birth canal is bot
obstructed
• Cesarean section if placental
placement prevents vaginal birth.
• In previa, CLASSICAL CS is indicated as
the lower uterine segment is occupied
by the placenta.
• Future pregnancies will be terminated
by another CS because the presence
of a CLASSICAL CS SCAR IS A
CONTRAINDICATION TO VAGINAL
DELIVERY
o leading the cause of UTERINE
RUPTURE.

RICCI D. CASTRO / BSN 2

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