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Placenta Previa: Nursing Care Plan
The placenta plays an essential role for the developing fetus during pregnancy. The placenta implants in the upper portion of the endometrium 6-7 days following conception (Vahanian et.al.,2016). This process is critical for a healthy pregnancy and delivery. Improper implantation of the placenta which partially or completely covers the cervix, is called placenta previa. Placenta previa is a severe risk of for postpartum hemorrhage which is the leading cause of maternal mortality worldwide (Glymph, 2016). The etiology of placenta previa is unknown however, there are several risk factors that attributes to its occurrence. Cigarette smoking has become a major risk factor due to its vasoconstrictor reaction from nicotine and carbon monoxide. This compromises placenta blood flow leading to abnormal placentation (Michaela Granfors et. al., 2019). Other risk factors include advanced maternal age, history or curettage, cocaine use and uterine scarring. A diagnosis of placenta previa will require a cesarean section for delivery to help reduce further complication.
Location of the placenta cannot be visualized until the second or third trimester making it difficult for an early diagnosis. Those patient with increased risk factors may have routine sonography in the first and second trimester for early detection of abnormalities (Pedigo, 2019). Painless vaginal bleeding with or without stimulation, is the hallmark sign of placenta previa. Until it is ruled out, the nurse should suspect placenta previa and the assessment is ongoing to prevent potential lethal complications to mother and fetus. The nurse should asses vital signs routinely as well as, continued monitoring of blood loss. Fetal heart rate should be monitored for responses and a tocodynamometer is used if uterine contractions are occurring. The nurse should refrain from performing any vaginal exams to prevent perforation of the placenta. The nurse should observe the coping ability of the family and assess their level of stress and anxiety (London, et al., 2017).
Development of the placenta occurs during fertilization of the ovum. Its primary function is to nourish and remove the waste of the fetus. Once improperly implanted in the lower uterus, the placenta continues to grow covering the os. The cervical os can be completely, partially or marginally, when the placenta edge is within 2cm of the internal os, covered by the placenta (Granfors et. al, 2019)). As the lower part of the uterus begins to thin in the second to third trimester, bleeding occurs causing the covered cervical area to bleed. Hemorrhage is the greatest risk of placenta previa putting both the mother and baby at risk for mortality. As bleeding occurs maternal blood volume is loss causing hypotension. This decreases perfusion to the placenta impairing gas exchange to the fetus. The amount of blood loss is related to the amount of area covered by the placenta with the greatest loss being a complete coverage. A diagnose of placenta previa is confirmed by transabdominal ultrasound.
The patient with a diagnosis of placenta previa is scheduled for cesarean delivery at 36-37 weeks’ gestation. Patients that present with excessive or continuous vaginal bleeding should delivery regardless of gestational age. Preparation prior to any procedure for these patients is essential. The nurse should have intravenous line access at two different sites with a complete blood count completed. A type and screen of the patients’ blood should be done, and 2-4 units of whole blood are crossed and matched (Feng et. al. 2018). The nurse should record intake and output and have fluids ready for treatment of hypovolemia if it occurs. One of the main goals during delivery with placenta previa, is to prevent hemorrhage and decrease blood loss. The nurse may prepare the patient for an abdominal aortic balloon occlusion, a minimally invasive procedure that reduces the amount of blood loss during cesarean delivery (Peng, 2019).
The nurse incorporates interventions to reduce the risk of complications to mother and baby. Measuring vital signs including intake and output, is a quick noninvasive tool that helps detect abnormal changes that may occur. Continuous monitoring of the fetus and uterine activity is important in determining the response to blood loss (London et. al, 2017). An important role of the nurse if to provide emotional support for the family. Allow questions to be asked and obtain needed information if requested. The nurse should maintain communication when providing care and explain any procedures or treatments given. The nurse is responsible for promoting neonatal physiologic adaptation through monitoring of hemoglobin, cell volume and erythrocyte count. Upon delivery the newborn may require blood administration, oxygen or admittance into the neonatal intensive care unit (London et. al, 2017).
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London, Ladewig, Davidson, Ball, Bindler, & Cowen. (2017). Maternal & Child Nursing Care.
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Michaela Granfors, Olof Stephansson, Margit Endler, Maria Jonsson, Anna Sandström and Anna‐Karin Wikström, (2019). Placental location and pregnancy outcomes in nulliparous women: A population‐based cohort study, Acta Obstetricia et Gynecologica Scandinavica, 98, 8, (988-996).
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Peng, Z. H., Xiong, Z., Zhao, B. S., Zhang, G. B., Song, W., Tao, L. X., & Zhang, X. Z. (2019).
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hemorrhage in patients with placenta previa or accreta. Experimental and therapeutic Medicine, 17(2), 1492–1496. doi:10.3892/etm.2018.7066
Vahanian SA, Vintzileos AM.(2016). Placental implantation abnormalities: a modern approach.
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