BORA INSTITUTE OF ALLIED HEALTH SCIENCES,

LUCKNOW

OBSTETRIC AND GYNECOLOGY

CASE STUDY
ON
“PLACENTA PREVIA”

SUBMITTED TO- SUBMITTED BY-

Mrs. SANDHYA VERMA BABLEE BHARTI
HOD OF OBG M.Sc. (N) 2nd year
Bora Institute of nursing Bora Institute of nursing

DATE OF SUBMISSION

07/07/2023
PATIENT PROFILE
1)-IDENTIFICATION DATA-
 Name- Mrs. Shakeela Khatoon
 Age- 26 year
 Sex- Female
 Address- Chinhat
 IP Number- 127659
 Ward- ANC Word
 Education- B.A. Pass
 Occupation- housewife
 Religion- Muslim
 Nationality- Indian
 Marital status- Married
 Date of admission– 13/06/2023
 Diagnosis- Placenta Previa
 Duration of marriage- 4 year
 Gravida- 2
 Para- 2
 Abortion- 1
 Living- 0
 Blood group- B+ve
 Husband name- Mr Arif Khan
Age- 30
Education - B.E.D. pass
Occupation- private job

2) - Chief complaints -Mrs. Shakeel Khatoon is admitted in ANC word on 13/06/2023 with the
complaint of she having bleeding 1 episode on 11 06/ 2023 and general weakness.
3) History of illness- Patient having nausea vomiting
4) Menstrual History-
 Age of menarche- 14year
 Duration of menstrual cycle- 28-30 days
 Duration of cycle in day- 3-4 days
 Regularity- Regular
 Amount of flow- Aedqucate
 LMP- 12/4/2023
 EDD- 19/11/2023
 Associated complaint- No any associated complaint.
 Contraceptive History- No any contraceptive History
  Antenatal attendance-
Date – 20/6/2023
Weight- 50kg
Pallor- Normal
Edema- Absent
Blood Pressures- 130/80mmHg
Height- 160cm
Presentation/ position- Logitudinal / cephalic
FHS- 140b/m
HB- 11.3gm/dl
Urine- Normal
Albumin- Nil g/dl
Sugar- 105mg/dl
Treatment- Iron, folic acid

5)Obstetric History-
 History of previous pregnancy- Present
 Period of pregnancy- 20 weeks

6)Present pregnancy-
 Date of booking- 20/6/2023
 Number of visits- 2 visits
 History of minor aliments- Nousea, vomiting, abdominal pain.

7)-Medical/Surgical history-
 Past medical history -No significant of past medical history.
 Present Medical history-Mrs. Shakeela Khatoon is admitted in ANC word on
13/06/2023 with the complain of bleeding, general weakness, vomiting under treatment
of Dr. S.P. Jaiswal. He is Diagnosed her as Placenta Previa.
 Past surgical history- No significant of past medical history.

8)-Socio-economic history-
 Bread winner of Family-Mr. Hashmatullaha.
 Socio-economic status-Satisfactory
 Type of house-Pakka
 Market Facility-Available
 Drainage System-Close
 Defecation System-Own Toilet
 Method Of refuse Disposal-Dumping

9) - Family History-
 Family Tree-
Type of family-Nuclear
 Head of family-Mrs. Shabna Khatoon

 Family Composition-

Sr.no. Name of Relationship Age Sex Education Occupation Health

family with patient status
Member
1 Mr. Father in law 56 M Graduation Teacher Healthy
Hashamatu years
llaha
2 Mrs. Mother in law 54 F 5th House wife Healthy
Shabna years
Khatoon
3 Mr. Arif Husband 30 M Graduation Teacher Healthy
Khan years
4 Mrs. Patient 29 F B.A. Pass House wife Unhealthy
Shakeela year
Khatoon
5 Mrs. Sister in low 24 F Bsc Housewife Healthy
Afreen year
Khatoon

 Family Medical History- No significant

6)- Personal History-

 Nutrition- She is Non-Vegetarian
 Sleep-Normal
 Habits-She is having no any bad habits like smoking and tobacco chewing.
 History of known allergy-No allergy
 Elimination Pattern-Normal elimination pattern.
PHYSICAL EXAMINATION
GENERAL APPEARANCE-
 Body built- Moderate
 Posture- Normal Posture
 Level of consciousness-consciouss
 Orientation- oriented to time, place, person
 Activity- Active
 Behaviour- Co oprative
 Attitude-Co-operative
 Speech-Slow
 Cleanliness-Clean
VITAL SIGN-
 Temperaure-98.6 F
 Pulse-90 beats / min
 Blood Pressure- 130/80 mmHg
 Respiratory Rate-22 breaths / min

ANTHROPOMETRIC MEASUREMENT-
 Height-160 cm
 Weight-76 kg
 Abdominal Grith-56 cm
SKIN-
 Color-Fair
 Turgor-Normal
 Texture-Smooth
 Pigmentation-Present
 Temperature-Warm
 Sensitivity-sensitive
 Lesion-Present
 Scar-absent
HEAD-
 Shape-Normal
 Symmetry- Symmetrical
 Scalp-clean
 Dandruff-Absent
 Pediculi-Absent
 Lesions-Absent
 Hair-present
  Color- Black
 Texture-Normal
 Distribution-Evenly Distributed
FACE-
 Symmetry-Symmetrical
 Facial Movement- Symmetrical
 Facial Puffiness-present
 Sinuses-Normal
EYES-
 Eye Brows-Present
 Symmetry-Symmetrical
 Distribution of hair-Equally Distributed
 Lesion-Absent
 Dandruff-Absent
EYELIDES-
 Movement-Completely
 Position-Normal
 Puffiness-Absent
 Lesion-Absent
 Style-Absent
EYE LASHES-
 Distribution –Normal
 Dandruff-Absent
EYE BALL-
 Position-Normal
 Movement-Normal
 Conjunctiva-Normal
 Sclera-Normal
 Cornea-Transparent
 Visual Acuity-normal
 Use of Spectacles or contact lenses—No
EARS-
 Position-Normal
 Symmetry-Symmetrical
 Size and Shape-Normal
 Lesion and Lump of Pinna-Absent
 External Auditory Canal-Normal and Visible
 Mastoid Process- Normal
  Use Of hearing Aids-No
 Pain-Absent
NOSE-
 Nasal Septum-Normal
 Polyps-Present
 Mucus Membrane-Dry
 Discharge-No
MOUTH-
LIPS
 Color-pick
 Hydration-Dry
 Symmetry-Symmetrical
 Lesion-Present
 Mucus Membrane
 Color-Normal
 Hydration-Poor

TEETH-
 No. of Teeth- 32
 Color-Stained
 Alignment-Normal
 Use of Denture-NO
GUMS- Healthy
Tongue-
 Color-coated
 Hydration-dry
 Lesions-Absent
 Thickness-Normal
 Frenulum- Toungue Tie
PALATE- Normal
UVULA-Midline
TONSIL-Normal
DYSPHASIA-Present
ODOR OF MOUTH- Normal
NECK-
 Range of Motion-Possible
 Thyroid Gland-Normal
 Trachea-midline
  Lymph Node-Palpable
 Jugular vein-distented
CHEST-
INSPECTION-
 Shape-Normal
 Movement-Symmetrical
 Retraction-Present
 Respiratory Rate-22 Breaths / Min
 Location of sternum-Midline
BREAST-
 Shape-Symmetrical
 Position-Normal
 Nipple-Cracked
PALPATION-
 Axillary Lymph Node-palpable
 Respiratory movement-symmetrical
 Fremitus-Normal
AUSCULATATION-
 Lung Sound-Clear & equal
 Heart Beat-92 Beats/min
 Heart sound-Normal
ABDOMEN-
INSPECTION-
 Shape-Rounded
 Skin-Thick
 Distension-Present
 Peristalsis-Not visible
 Distended-Absent
 Umbilicus-Normal
PALPATION-
 Hepatomegaly-Absent
 Spleenomegaly-Absent
 Tenderness-Present
 Mass-Absent
AUSCULTATION-
 Bowel Sound -Increased
 Character-Gurgring sound
PERCUSSION-
Ascitis-Absent
Fluid Thrill-Absent
BACK-
 Tenderness-Absent
 Mass-Absent
GENITALIA –
 Anal opening- Clear
 Perineal fissure-Absent
 External heamorrhoids-Absent
FEMALE
 Urethral opening-clear
 Lesion-Absent
 Discharge-Present
EXTRIMITIES-
 Position-Symmetrical
 Gait-Normal
 Range of Motion-Normal
 Congenital deformity-Absent
 Digits- normal(5+5,5+5)
NAIL-
 Shape- Normal
 Color- pink
 Capillary refill time- <2 sec
REFLEX-
 Biceps Reflex-Normal
 Triceps Reflex-Normal
 Patellar Reflex-Normal
VITAL SIGN.

VITAL SIGN PATIENT NORMAL REMARK

VALUE VALUE

Temperature 98.6 F 98.6 F Increases

Pulse Rate 90 Beats / min 70-80 beats/min Increases

Blood Pressure 130/80 mmHg 120/90 mmHg Normal

Respiratory Rate 22 Breaths / Min 16-20 breaths/min Trachypneoa

INVESTIGATION CHART
INVESTIGATION PATIENT NORMAL REMARK
VALUE VALUE
 Hemoglobin 10.1gm/dl 12.5gm/dl Decrease
 TLC 9900cells/mm3 4000- Normal
11000cells/mm3

 Differential %
Leukocytes
count-

70% 40-80 Normal

 Neutrophills 26% 20-40 Normal
 Lymphocyte 02% 1-6 Normal
 Eosinophills 02%
 Monocyte 00%
2.81Lac million 1.5-4.5 Normal
 Basophill
cells/ul
 Platelet count
9.4fl
3.29milliocells/ul 3.8-4.8 Normal
 MPV
25.8pg 27-32 Decrease
 Total RBc Decrease
26.1% 36-46
 MCH Normal
1.22 mg/l 0-6
 HCT(Hemocrit)
 C- reactive protein
Thyroid profile-
Normal
 Serum T3 0.98ng/ml 0.58-1.59ng/ml
6.65ug/dl 4.87-11.72ug/dl Normal
 Serum T4 Normal
2.32ug/ml 0.35-4.94ul/ml
 Serum TSH
MEDICATION CHART

DRUG DOSE ROUTE FREQUENCY MECHANISM

OF ACTION
BD Antiallergic
Inj. 3.3mg/ml IV/ IM
Dexamethasone

OD Mineral
Tab. Iron 1mg Oral supplement

OD Ca Supplement
Tab. Calcium 1mg Oral

OD Folic acid
Tab. Folic acid 1mg Oral supplements
 ANATOMY AND PHYSIOLOGY OF PLACENTA

PLACENTA-
The placenta develops within the uterus during pregnancy, playing a key role in nourishing and
providing oxygen to the fetus, as well as removing waste material. This organ is attached to the
wall of the uterus, with the baby’s umbilical cord arising from it. Throughout the course of a
pregnancy, the placenta grows and changes shape, with its thickness being a reliable measure of
how far along the mother-to-be is in gestation. Furthermore, a number of disorders can impact
this organ, including placenta previa, in which some or all of the cervix is covered by the
placenta, as well as placenta accreta malformations, which involve different degrees of
implantation within the uterine wall.

Structure and Location

The largest fetal organ, the placenta undergoes rapid development over the course of pregnancy.
By the time the baby is brought to term, it has a flat, round disc-like shape that is about 22
centimeters (cm) in diameter, with walls that are typically between 2 and 2.5 cm.3
The placenta typically sits along the back wall of the uterine wall—about 6 cm from the cervix—
occasionally accessing the side walls throughout its course of development. Significantly, the
umbilical cord
(which brings in nutrients and oxygen and takes out waste material) connects the mid-section of
the fetus to the placenta; in turn, the fetus is surrounded by the amniotic or gestational sac.
 Maternal component: Essentially, this is the portion of the placenta that is formed of the
mother’s endometrium or the maternal uterine tissue. It forms what is called the decidua
basalis, or maternal placenta.
 Fetal component: Also known as the chorion frondosum or villous chorion, this is the
portion of the placenta arising from the blastocyte.
 Function
The placenta plays an absolutely crucial and essential role during the nine months of pregnancy.
Via the umbilical cord and the chorionic villi, this organ delivers blood, nutrients, and oxygen to
the developing fetus. In addition, it works to remove waste materials and carbon dioxide. As it
does so, it creates a differentiation between maternal and fetal blood supply, keeping these
separate via its membrane.
Furthermore, the placenta works to protect the fetus from certain diseases and bacterial infections
and helps with the development of the baby’s immune system. This organ also secretes
hormones—such as human chorionic gonadotropin, human placenta lactogen, and estrogen—
necessary to influence the course of pregnancy and fetal growth and metabolism, as well as labor
itself.
 DISEASE CONDITION

INTRODUCTION-
The placenta signifies the "second" or "embryonic" period of pregnancy (after the implantation
period) and describes the establishment of a fully functional placenta. The placenta is an
apposition of foetal and parental tissue for the purposes of physiological exchange. There is little
mixing of maternal and foetal blood, and for most purposes the two can be considered as
separate.
DEFINITION-
The placenta is implanted partially or completely over the lower uterine segment (over or
adjacent to the internal os) it is called Placenta Previa.
OR
In Placenta Previa the placenta is implanted in the lower uterine segment such that is completely
or partially cover the cervix or is close enough to the cervix to cause bleeding when the cervix
dilated or the lower uterine segment effaces.
INCIDENCE-
In 80% cases it is found in multiparous women. • The incidence is increased beyond the age of
35, with high birth order pregnancies and in multiple pregnancy. • The incidences approximately
4-5 per thousand pregnancies.
TYPES-
There are four types of placenta praevia depending upon the degree of extension of placenta to
the lower segment.
• Type 1 (Low lying)
• Type 2 (Marginal)
• Type 3 (Incomplete or partial central)
• Type 4 (Central or total)
 Type 1 (Low lying): The major part of placenta is attached to the upper segment and
only the lower margin encroaches onto the lower segment but not to the os.
 Type 2 (Marginal): The placenta reaches the margin of internal os but does not
cover it.
 Type 3 (Incomplete or partial central) : The placenta covers the internal os partially (
cover the internal os when closed but does not entirely do so when fully dilated)
Type 4 (Central or total) : The placenta completely covers the internal os even after it is fully
dilated.
RISK FACTORS-

BOOK PICTURE PATIENT PICTURE

 Multiparity  Multiparity

 Increased maternal age

 History of previous scar in the uterus.

 Smoking

ETIOLOGY-

BOOK PICTURE PATIENT PICTURE

 Dropping down theory -

 Persistence of chorionic activity -

 Defective decidua  Defective decidua

 Big surface area of placenta -

CLINICAL MANIFESTATION-

BOOK PICTURE PATIENT PICTURE

 Vaginal bleeding  Vaginal bleeding

 Bleeding is painless  Bleeding is painless

 Bleeding is causeless -

 Haemorrhage -

DIAGNOSTIC EVALUATION-

BOOK PICTURE PATIENT PICTURE

 History collection  History collection

 Physical examination  Physical examination

 Blood examination  Blood examination

 Magnetic Resonance Imaging  MRI

MEDICAL MANAGEMENT-

BOOK PICTURE PATIENT PICTURE

 Adequcate Antenatal care  Adequcate Antenatal care

 Antenatal diagnosis  Antenatal diagnosis

 Warning Haemorrhage -

 Colour flow Doppler USG -

NURSING MANAGEMENT-

BOOK PICTURE PATIENT PICTURE

 Perform assessment and test of  Perform assessment and test of

placenta Previa placenta Previa

 Monitor blood pressure according to  Checked blood pressure

clinical situation

 Monitor regular fetal heart rate  Monitor regular fetal heart rate
NURSING DIAGNOSIS

 Deficient fluid volume related to active Blood loss secondary to disrupted Placental
implantation.
 Impaired fetal gas exchange related to altered blood flow and decreased surface area of
gas exchange at site of Placenta detachment.
 Decreased cardiac output related to altered contractility.
 Ineffective tissue perfusion related to decreased Hb concentration in blood and
hypovolemia.
 Knowledge deficit related to diseases condition as evidenced by asking frequent question.
 NURSING CARE PLAN

ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION

SUBJECTIVE Deficient fluid To -Monitor -Monitored vital sign, After nursing

DATA- Patient volume related improve vital sign capillary refill, skin intervention
is complaining to active Blood the fluid ,capillary color& mucus improved the
of that she is loss secondary volume. refill, skin membranes. condition of
feeling fluid to disrupted color& patient.
loss. Placental mucus
implantation. membranes.

-Examine -Examined and

and document the presence
document the of color, odor and
presence of amount of bleeding by
color, odor used of the no. of pad.
and amount
of bleeding.

-Observation -Observed of a delay in

OBJECTIVE of a delay output and input chart.
DATA- On output and
observation of input chart. Input Output
patient- 100 150
Pallor 200 250
Respiratory
rate- 22 breaths/ -Advice to -Adviced to patient
min patient to intake Nutrient
intake supplement, green lefy
Nutrient vegetable, protein rich
supplement diet.
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION

SUBJECTIVE Ineffective To -Assess the -Assessed the general After nursing

DATA- Patient tissue improve general condition of the patient. intervention
is complaining perfusion the HgB condition of improved the
of that she is level of the patient. tissue perfusion
related to
feeling tingling the of the patient.
in the finger. decreased HgB -Monitored vital sign of
patient. -Monitor
concentration vital sign of the patient.
in blood and the patient. Temp.-98.6F
hypovolemia Pulse-86b/m
Resp.-22b/m

-Check the -Checked the weight of

weight of the the patient.
patient Weight-68kg

-Provide the -Provided the fluid to

fluid to the the patient
OBJECTIVE patient.
DATA- On
observation of -Provide the -provided the quiet and
patient- quiet and restful environment.
dryness, restful
Respiratory environment.
rate- 22 breaths/
min
ASSESSMENT DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION

SUBJECTIVE Knowledge To -Assess the -Assessed the After nursing

DATA- Patient deficit related improve knowledge knowledge about intervention
is say she is not to diseases the about disease disease condition. improve the
have knowledge knowledge condition. patient
condition as
about disease. of the knowledge
evidenced by patient. level.
asking -Clearify the
frequent all doubts of
-Clearified the all
question. doubts of the patients
the patients.
regarding disease and
investigation.

-Provided the some

-Provide the
knowledge about the
knowledge
personal hygiene.
OBJECTIVE about the
DATA-On personal
observation- hygiene.
patient not have
knowledge
about disease. -Provided the
-Provided the emotional
emotional
support of the patient.
support of the
patient.
HEALTH -EDUCATION
1. Diet- Educate the patient to take proper and healthy diet. Advice the patient to take

balance diet. And advice the patient to take Iron rich and green vegetables.

2. Hygiene- Educate the patient to maintain her personal hygiene and to avoid other

infection. And take proper bath daily.

3. Medication- To teach the patient to take medication daily in the time and do not skip

any medicine.

4. Exercise- Educate the patient about active and passive exercise. Educate the patient

for bed rest.

5. Follow-up- educate the patient about regular follow-up care.

 BIBLIOGRAPHY

 Dutta DC ‘A Textbook of obstetric’, 6th Edition, Jaypee publisher’s page no. 244-248.

 Sanju Sera ‘A Textbook of obstetrics and Gynecology’, 4th Edition, lotus publishers, page
no. 520-530.