Placenta previa is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. Placenta previa is a life-threatening maternal bleeding typically necessitates termination of the pregnancy. Maternal prognosis is good if hemorrhage can be controlled; fetal prognosis depends on the gestational age and amount of blood lost. Anemia may be managed by blood transfusion to permit the pregnancy to continue in utero. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum hemorrhage (vaginal bleeding). It affects approximately 0.5% of all labors.
Nursing Care Plans
Treatment of placenta previa is design to assess, control, and restore blood loss, and to deliver a viable infant. Immediate therapy includes starting an IV line using a large bore catheter. Here are 3 placenta previa nursing care plans.
1. Deficient Fluid Volume
Fluid volume deficit is a state in which an individual is experiencing decreased intravascular, interstitial and/or intracellular fluid. Active blood loss or hemorrhage due to disrupted placental implantation during pregnancy may manifest signs and symptoms of fluid vol. deficient that may later lead to hypovolemic shock and cause maternal and fetal death.
Assessment
Patient may manifest:
- Bleeding episodes (amount, duration)
- Abdomen soft/hard when palpated
- Manifests body weakness
- Low blood pressure
- Increased heart rate
- Decreased respiratory rate
- Fetal heart rate less than normal (120-160 bpm)
- Decreased urine output
- Increased urine concentration
- Pale, cold, clammy skin
Nursing Diagnosis
- Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Planning
- Patient will maintain fluid volume at a functional level possibly evidenced by adequate urinary output and stable vital signs.
| Nursing Interventions | Rationale |
|---|---|
| Establish Rapport | To gain patient’s trust |
| Monitor Vital Signs | To obtain baseline data |
| Assess color, odor, consistency and amount of vaginal bleeding; weigh pads | Provides information about active bleeding versus old blood, tissue loss and degree of blood loss |
| Assess hourly intake and output. | Provides information about maternal and fetal physiologic compensation to blood loss |
| Assess baseline data and note changes. Monitor FHR. | Assessment provides information about possible infection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms. |
| Assess abdomen for tenderness or rigidity- if present, measure abdomen at umbilicus (specify time interval) | Detecting increased in measurement of abdominal girth suggests active abruption |
| Assess SaO2, skin color, temp, moisture, turgor, capillary refill (specify frequency) | Assessment provides information about blood vol., O2 saturation and peripheral perfusion |
| Assess for changes in LOC: note for complaints of thirst or apprehension | To detect signs of cerebral perfusion |
| Provide supplemental O2 as ordered via face mask or nasal cannula @ 10-12 L/min. | Intervention increases available O2 to saturate decreased hemoglobin |
| Initiate IV fluids as ordered (specify fluid type and rate). | For replacement of fluid vol. loss |
| Position Pt. in supine with hips elevated if ordered or left lateral position. | Position decreases pressure on placenta and cervical os. Left lateral position improves placental perfusion |
| Monitor lab. Work as obtained: Hgb & Hct, Rh and type, cross match for 2 units RBCs, urinalysis, etc. Scheduled for ultrasound as ordered. | Lab Work provides information about degree of blood loss; prepares for possible transfusion. Ultrasound provides info about the cause of bleeding |
2. Decreased Cardiac Output
Placenta Previa is the development of placenta in the lower uterine segment partially or completely covering the internal cervical os. Placenta Previa causes bleeding. Due to large amounts of blood lost, the heart tries to pump faster in order to compensate for blood loss. As a result, the heart pumps faster with lesser blood pumped.
Assessment
- dysrhythmias
- prolonged capillary refill
- cold clammy skin
- Dyspnea
- restlessness
- variations in BP reading
Nursing Diagnosis
- Decreased cardiac output r/t altered contractility
Planning
- Patient will participate and demonstrate activities that reduce the workload of the heart.
- Patient will manifest hemodynamic stability.
| Nursing Interventions | Rationale |
|---|---|
| Establish Rapport | To gain patient’s trust |
| Monitor Vital Signs | To obtain baseline data |
| History taking | To determine contributing factors |
| Assess patient condition | To assess contributing factors |
| Review lab data | For comparison with current normal values |
| Monitor BP & Pulse frequently | To note response to activity |
| Provide information on test procedures | To gin pt’s participation |
| Provide adequate rest & Reposition client | To promote venous return |
| Encourage relaxation techniques | To alleviate stress & anxiety |
| Elevate HOB | To promote circulation |
| Encourage use of relaxation techniques | To decrease tension level |
3. Ineffective Tissue Perfusion
Placenta Previa causes painless and continuous bleeding. With bleeding, there is decreased Hemoglobin. Hemoglobin carries oxygen to different parts of the body. If there is decreased hemoglobin there is a failure to nourish the tissues at the capillary level.
Assessment
Patient may manifest
- Restlessness
- Confusion
- Irritability
- Manifest Body Weakness
- Capillary refill more than 3 sec
- Oliguria
Nursing Diagnosis
- Ineffective tissue perfusion r/t decreased HgB concentration in blood & hypovolemia
Planning
- Patient will demonstrate behaviors to improve circulation.
- Patient will demonstrate increased perfusion as individually appropriate.
| Nursing Interventions | Rationale |
|---|---|
| Establish Rapport | To gain patient’s trust |
| Monitor Vital Signs | To obtain baseline data |
| Assess patient condition | To assess contributing factors |
| Note customary baseline data (usual BP, weight, lab values) | For comparison with current findings |
| Determine presence of dysrhythmias | To identify alterations from normal |
| Perform blanch test | To identify and determine adequate perfusion |
| Check for Homan’s Sign | To determine presence of thrombus formation |
| Encourage quiet & restful environment | To lessen O2 demand |
| Elevate HOB | To promote circulation |
| Encourage use of relaxation techniques | To decrease tension level |
Other Possible Nursing Care Plans
- Risk for Deficient Fluid Volume: risk factors may include excessive vascular losses
- Impaired fetal Gas Exchange: may be related to altered blood flow, altered O2-carrying capacity of blood from maternal anemia, and decreased surface area of gas exchange at site of placental attachment, possible evidenced by changes in fetal heart rate/activity and release of meconium.
- Fear may be related to threat of death to self or fetus, possibly evidenced by verbalization of specific concerns, increased tension, sympathetic stimulation.
- Risk for Deficient Diversional Activity: risk factors may include imposed activity restrictions or bed rest.
See Also
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Further Reading
Select books and recommended resources
- Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family
- Maternal Child Nursing Care
- Maternal-Child Nursing, 4e
- Maternal Newborn Nursing Care Plans
- Delmar’s Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans
