Name: Martinez, Erica M.

Year & Section: BSN 4 -A

Clinical Instructor: Frances Anne C. Reyes Clinical Area: LR/DR

PLACENTA PREVIA

Placenta Previa is a condition during pregnancy where the placenta blocks the opening to the cervix
that allows the baby to be born. It can cause severe bleeding during pregnancy and delivery. Mothers with
placenta previa are also at hinger risk of delivering prematurely, before 37 weeks of pregnancy.

Placenta previa happens when the placenta partly or completely covers the cervix, which is the
opening of the uterus. Your baby passes into the cervix and through the birth canal during a vaginal
delivery. Normally, the placenta does not attach near the cervix.

Here’s what happen with placenta previa: As your cervix opens during labor, it can cause blood
vessels that connect the placenta to the uterus to tear. This can lead to bleeding and put both you and your
baby at risk. Women who have this condition will have a C-section to keep this from happening.

Types of placenta previa:

 Complete previa is when the placenta covers the entire opening of the cervix.
 Marginal previa, also called low-lying placenta, is when the placenta is close to the opening of
the cervix but doesn’t cover it. It may get better on it’s own before the baby is due.

SYMPTOMS:
You might notice:
 Bright red bleeding from your vagina during second half of your pregnancy. It range from
light to heavy, and it’s often painless.
 Mild cramping or contraction in your abdomen. You might feel the cramping or tightening
that comes with contractions, or feel pressure in your back.
If you have bleed too much, you may have other symptoms, such as anemia, pale skin, rapid and
weak pulse, shortness of breath, or low blood pressure.

RISK FACTORS:
 You cigarette or use cocaine
 You smoke cigarette or use cocaine.
 You're 35 64 older.
 Pregnant several times before.
 Pregnant with twins, triplets or more.
 Had surgery on your uterus, including CS or D&C (dilation or curettage).

COMPLICATIONS:
 Bleeding. Severe bleeding can occur during pregnancy labor delivery.
 Early birth- If you're bleeding severely. your health care provider may perform the emergency c-
section before your baby is full term (40 weeks).
 Blood loss- Shortness anemia, low BP, pale skin or shortness of breath are all side effects of
losing too much blood.
 Placenta accreta. The placenta grows too deeply. This can cause severe bleeding after birth.
 Placenta abruption: The placenta separates from your uterus before your baby is born. This
decreases your baby's supply of oxygen and nutrients.
Baby:
 Premature birth: If your bleeding is severe and you need an Emergency c-section. Your
baby may be born too early.
Name: Martinez, Erica M. Year & Section: BSN 4 -A
Clinical Instructor: Frances Anne C. Reyes Clinical Area: LR/DR

 Low birth weight. Trouble staying warm and poor weight gain potential side effects of low
birth weight.
 Respiratory issues. underdeveloped lungs could make breathing more difficult.

DIAGNOSTIC TEST:
Usually identify placenta previa n a routine ultrasound around 20 weeks of pregnancy to monitor the
placement of the placenta for the remainder of your pregnancy.

Tw types of ultrasound:
 Vaginal ultrasound (or transvaginal ultrasound): Your provider places a wand-like device (a
transducer) into your vagina to check the position of your baby, the placenta and your cervix.
 Abdominal ultrasound: Your provider places gel on your abdomen, then moves a handheld
device (the transducer) around the outside of your belly. This can also show the position of your
baby, the placenta and your cervix.

NURSING INTERVENTIONS:
 Assess color, odor, consistency, and amount of vaginal bleeding. Inspect the perineum for
bleeding and estimate the present rate of blood loss. The bleeding with placenta previa is usually
abrupt, painless, bright red, and sudden. The bleeding may be provoked by intercourse, vaginal
examinations, or labor, and at times there may be no identifiable cause.
 Monitor the client’s vital signs. Obtain baseline vital signs to determine whether symptoms of
hypovolemic shock are present. Continue to assess blood pressure every 5 to 15 minutes or
continuously with an electronic cuff. Signs of hypovolemic shock include hypotension,
tachycardia, and tachypnea.
 Monitor the fetal heart rate and uterine contractions continuously. Attach external monitoring
equipment to record fetal heart sounds and uterine contractions; however, avoid the use of an
internal monitor for either fetal or uterine assessment to prevent hemorrhage. Fetal hypoxia may
occur if a large disruption of the placental surface reduces the transfer of oxygen and nutrients.
 Weigh perineal pads to estimate blood loss. Weighing perineal pads before and after use and
calculating the difference by subtraction is a good method to determine vaginal blood loss.
 Avoid vaginal examinations. Because of the risk of provoking life-threatening hemorrhage, a
digital examination of the vagina is absolutely contraindicated until placenta previa is excluded.
Instruments should not be placed near the cervix because uncontrolled bleeding can result. If
placenta previa is suspected and ultrasound is unavailable, the provider may perform a vaginal
examination with preparations for both vaginal and cesarean births (a double set-up) in place.
 Position the client supine with hips elevated if ordered or in a left side-lying position. To ensure
an adequate blood supply to the client and fetus, place the client immediately on bed rest in a left
side-lying position. The left side-lying position decreases pressure on the placenta and cervical os
and improves placental perfusion.
 Prepare for a vaginal or cesarean birth. Vaginal birth is always safest for the infant. If the previa
is under 30% by abdominal or transvaginal ultrasound, it may be possible for the fetus to be born
past it. If over 30% and the fetus is mature, the safest birth method for both mother and baby is
often cesarean birth.
Name: Martinez, Erica M. Year & Section: BSN 4 -A
Clinical Instructor: Frances Anne C. Reyes Clinical Area: LR/DR

PLACANTA ACCRETA

Placenta accreta is a serious pregnancy conditions that occurs when the placenta grows too deeply
into the uterine wall, sometimes near the cervix. Typically, the placenta detaches from the uterine wall
after childbirth. With placenta accreta, part of all the placenta remains attached. This can cause severe
blood loss after delivery.

Placenta accreta is considered a high-risk Pregnancy complication. If the condition is diagnosed

during pregnancy, you'll likely need an early C- section delivery followed by the surgical removal of the
uterus (hysterectomy).

*HYSTERECTOMY – helps prevent the potentially life-threatening blood loss that can occur if
there’s an attempt to separate the placenta.

Types of placenta previa:

There are three types of placenta accreta. Providers determine the type based on how deeply the
placenta is attached to your uterus.
 Placenta accreta: The placenta firmly attaches to the wall of your uterus. It doesn't pass through
the wall of the uterus or impact the muscles of the uterus. This is the most common type.
 Placenta increta: In this type, the placenta is more deeply embedded in the wall of your uterus. It
still doesn't pass through the uterine wall but is firmly attached to the muscle of the uterus.
 Placenta percreta: The most severe of the types, placenta percreta happens when the placenta
passes through the wall of your uterus. The placenta might grow through your uterus and impact
other organs, such as your bladder or intestines.

SYMPTOMS:
Placenta accreta often causes no signs or symptoms during pregnancy – although vaginal bleeding
during the third trimester might occur or pelvic pain (from the placenta pressing on your bladder or other
organs).

RISK FACTORS:
You’re at risk placenta accreta if you:
 Have had previous cesarean deliveries.
 Have in an abdominal location in your uterus.
 Have had more than one pregnancy. The risk of placenta accreta increases as your number of
pregnancies increases.
 Maternal age. Placenta accreta is most common in women more than 35yeras old.

COMPLICATIONS:
 Premature delivery. Placenta accreta might cause labor to begin early. If placenta accreta
causes bleeding during your pregnancy, you might need to deliver your baby early.
 Heavy vaginal bleeding after delivery. The bleeding can cause a life-threatening condition
that prevents your blood from clothing and kidney failure.
 Damage to your uterus.
 Less of fertility due to hysterectomy.
Name: Martinez, Erica M. Year & Section: BSN 4 -A
Clinical Instructor: Frances Anne C. Reyes Clinical Area: LR/DR

DIAGNOSTIC TEST:
 Ultrasound – placenta accreta is detected during a routine ultrasound.
 Magnetic Resonance Imaging (MRI) – it can be helpful in some cases to show how deeply the
placenta has penetrated your uterine wall.

NURSING INTERVENTIONS:
 Assess vital signs (pulse, respirations, and blood pressure every 15 minutes to provide baseline
data on maternal bleeding.
 Assess and record the capillary refill in the nail beds and skin color. To determine the severity of
bleeding as well as to establish baseline data.
 Evaluate and record the amount of bleeding and appearance of blood such color and consistency.
To determine amount blood loss to help differentiate the diagnosis.
 Encourage to do bed rest to possibly stop or reduce bleeding by reducing physical activity.
 Encourage to drink enough amount of fluid to replenish the loss fluid volume in the body.
 Monitor amount of bleeding by weighing the used pad to determine whether the condition of the
patient is improving by deteriorating.