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,placenta previa
placenta implants into the lower uterus and may partially/completly cover the internal
cervial os
placenta previa risk factors
Previous placenta previa, prior C-section, multiple pregnancies, multiple gestation,
advanced maternal age, smoking, previous uterine surgery/curettage, multiparity
placenta previa: pathophysiology
Placenta develops in the lower uterine segment. As the lower uterus stretches and the
cervix changes later in pregnancy, the placenta can separate from the uterine wall →
maternal bleeding.
placenta previa: clinical manifestations
Painless, bright-red vaginal bleeding in the 2nd half of pregnancy; bleeding may be
sudden/recurrent; uterus usually soft and nontender; fetal malpresentation may occur.
, placenta previa: diagnostic testing
Ultrasound confirms placental location; transvaginal ultrasound is highly accurate when
performed appropriately. CBC/Hgb/Hct may assess blood loss; blood type/Rh and
crossmatch may be obtained.
placenta previa: nursing assessment
Monitor amount/color of bleeding, maternal VS, fetal heart rate, contractions, and signs
of hypovolemia/shock. Monitor CBC/Hgb/Hct. DO NOT perform a digital vaginal
examination until placenta previa has been excluded because it can trigger severe
hemorrhage.
placenta previa: medical managment
Depends on gestational age, amount of bleeding, fetal status, and type/location of
previa. May include pelvic rest/activity modification as ordered, IV access/fluids, blood
products if needed, corticosteroids such as betamethasone when preterm delivery is
anticipated, and Rh(D) immune globulin for eligible Rh-negative patients.
Significant/ongoing bleeding or complete previa generally requires cesarean delivery.
placenta previa: evaluation criteria
Maternal VS remain stable, bleeding decreases/does not worsen, fetal status remains
reassuring, adequate maternal perfusion is maintained, and patient understands when to
seek emergency care.
placenta previa exam points
Placenta previa = PAINLESS + BRIGHT RED bleeding + SOFT/NONTENDER uterus.
Most important: If placenta previa is suspected, NO DIGITAL VAGINAL EXAM until
placental location is established