Definition Placenta previa is a condition that occurs during pregnancy when the placenta is abnormally placed, and partially

or totally covers the cervix. Sign and Symptoms Sudden, painless vaginal bleeding that is light to heavy. The blood is often bright red. Symptoms of early labor, such as regular contraction and aches or pains in your lower back or belly. Medium to severe vaginal bleeding during the first trimester. Any vaginal bleeding in the second or third trimesters. Laboratory test
Placenta previa is diagnosed through ultrasound, either during a routine prenatal appointment or after an episode of vaginal bleeding.

A definitive diagnosis may require a combination of abdominal ultrasound and transvaginal ultrasound, which is done through a wand-like device placed inside your vagina. Your health care provider will closely monitor the location of the transducer in your vagina to prevent any bleeding. In rare instances, magnetic resonance imaging (MRI) may be used to clearly determine the placental location.

If your health care provider suspects that you may have placenta previa, he or she will avoid routine vaginal exams to reduce the risk of heavy bleeding. You may need additional ultrasounds to determine the exact location of your placenta before delivery. Your baby's heartbeat may be tracked as well.

NCP Assessment
S-O-> Bleeding Episodes (amount, duration) > Facial Grimace dueof Pain > Complaintof pain Abdomen soft/hard when palpated > Manifest Body Weakness > Low BP Increased HR

Nursing Dx
Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental Implantation.

Planning
Short Term:After 4 hours of NI, the pt will verbalize understanding of causative factors.Long Term: After 4 days of NI, the pt will maintain fluid volume at a functional level AEB individually adequate urinary output and stable vital signs.

Nursing Interventions
1. Establish Rapport2. Monitor Vital Signs3. Assess color, odor, consistency and amount of vaginal bleeding; weigh pads 4. Assess hourly intake and output. 5. Assess

Rationale
1. To gain patients trust2. To obtain baseline data3. Provides information about active bleeding versus old blood, tissue loss and degree of blood loss 4. Provides information about maternal and fetal physiologic compensation to blood loss

Expected Outcome
Short Term:The pt shall have verbalized understanding of causative factors.Long Term: The pt shall have maintained fluid volume at a functional level AEB individually adequate urinary output and stable vital signs.

baseline data and

Decreased RR Fetal HR >120-160 bpm > Decreased Urine Out > Increased Urine Concentration > Pale, Cool Skin >Increased Capillary Refill

note changes. Monitor FHR. 6. Assess

5.

Assessment

provides information about possible infection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms. 6. Detecting

abdomen for tenderness or rigidity- if present, measure abdomen at umbilicus (specify time interval) 7. Assess SaO2,

increased in measurement of abdominal girth suggests active abruption 7. Assessment

skin color, temp, moisture, turgor, capillary refill (specify frequency) 8. note forcomplaints of thirst or apprehension 9. Provide supplemental O2 as ordered via facemask or nasal cannula @ 10-12 L/min. 10. Initiate IV fluids as ordered (specify fluid type and rate). Assess for

changes in LOC:

provides information about blood vol., O2 saturation and peripheral perfusion 8. To detect

signs of cerebral perfusion 9. Intervention

increases available O2 to saturate decreased hemoglobin 10. For 11. Position Pt. in supine with hips elevated if ordered or left lateral position. 12. Monitor lab. Work as obtained: Hgb & Hct, Rh and type, cross match for 2 units RBCs, urinalysis, etc. Scheduled for 11. Position decreases pressure on placenta andcervical os. Left lateral position improves placental perfusion 12. Lab. Work provides replacement of fluid vol. loss

ultrasound as ordered.

information about degree of blood loss; prepares for possibletransfusion. Ultra sound provides info about the cause of bleeding