Placenta previa is the development of placenta in the lower uterine segment, partially or completely covering the internal cervical

os. The cause is unknown, but a possible theory states that the embryo will implant in the lower uterine segment if the deciduas in the uterine fundus is not favorable. Complications are immediate hemorrhage, shock, and maternal death; fetal mortality; and post partum hemorrhage. Signs and Symptoms: Vaginal bleeding Contractions

CASE STUDY
Patient X is a 37- year old Filipina female who is living with her family at Look, Salay, Misamis Oriental. She is from Quitoan, Bacolod. Her religion is Iglesia ni Cristo. She is a high school graduate, non-smoker, non alcoholic, and no allergies reported. Patient has placenta previa with bleeding during her delivery. Patient X was admitted last Novemer 29, 2009 at NNMC DR because of abnormal separation of the placenta. With that, patient X undergone cesarean section. Patient X is multigravida. She delivered a post term operative baby boy 43 weeks of gestation 3.4 kg with an APGAR score of 3,6,7 vertex, placenta previa, accreta with anemia. Patient X has two full term baby weighing 5 lbs and 6 lbs. Patient is referred to NNMC from Balingasag, Provincial Hospital. Vital signs The patient vital signs are one of the most important data that should be given a direct attention because it will serve as basis in determining any risk factors towards the patient. The increase and decreased of the vital sign of the patient must be monitored in order to determined whether the patient is at risk or not. The patient had the following vital signs upon admission: BP- 120/90 mmHg, PR- 80 bpm ; RR-22 cpm; and temp- 36c .

NURSING CARE PLAN

Assessment SO> Bleeding Episodes (amount, duration) > Facial Grimace due of Pain > Complaint of pain Abdomen soft/hard when palpated > Manifest Body Weakness > Low BP Increased HR Decreased RR Nursing Dx Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental Implantation Planning Short Term: Nursing Interventions 1. Establish Rapport Rationale 1. To gain patients trust 2. To obtain baseline data After 4 hours of NI, the pt2. Monitor Vital Signs will verbalize understanding of 3. Assess color, odor, causative factors. consistency and amount of vaginal bleeding; weigh Long Term: pads After 4 days of NI, the pt will maintain fluid volume at a functional level AEB individually adequate urinary output and stable vital signs. 4. Assess hourly intake and output. 5. Assess baseline data and note changes. Monitor FHR.

3. 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 5. Assessment provides information about possibleinfection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms.

6. Assess abdomen for tenderness or rigidity- if present, measure abdomen 6. Detecting increased in at umbilicus (specify time measurement of abdominal girth interval) suggests active abruption 7. Assess SaO2, skin color, temp, moisture, turgor, capillary refill (specify frequency)

7. Assessment provides information about blood vol., O2 saturation and peripheral perfusion 8. To detect signs of cerebral

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

8. Assess for changes in perfusion LOC: note for complaints of thirst or apprehension 9. Intervention increases available O2 to saturate decreased 9. Provide supplemental hemoglobin O2 as ordered via facemask or nasal cannula @ 10-12 10. For replacement of fluid vol. L/min. loss 10. Initiate IV fluids as ordered (specify fluid type and rate). 11. Position decreases pressure on placenta and cervical os. Left lateral position improves placental perfusion

11. Position Pt. in supine with hips elevated if ordered 12. Lab. Work provides information or left lateral position. about degree of blood loss; prepares for possibletransfusion. 12. Monitor lab. Work as Ultra sound provides info about the obtained: Hgb & Hct, Rh and cause of bleeding type, cross match for 2 units RBCs, urinalysis, etc. Scheduled forultrasound as ordered.

PATHOPHYSIOLOGY
Predisposing Factors
Age Gender Genetic Predisposition
Precipitating Factors History of Placenta Previa Multipara Women Smoking Over the age of 33 Surgery of the uterus Prior delivery of a baby via Cesarean Section History of uterine abnormalities

PLACENTA PREVIA

Increased Progesterone and Estrogen Level

Preembryonic Stage Production of fertilized ovum Implantation of the uterus Embryonic Stage Placenta arise from the thropoblast tissues Insufficient blood Placenta migrates to where there is sufficient blood supply Placenta resides in the lower Signs and Symptoms: Vaginal bleeding Contractions

Total Placenta Previa The placenta completely covers the top of the cervix

EFFECTS ON FETUS Low Lying Placenta Previa May have problems Marginal Placenta with his heart the The placenta reaches rate The placenta touches, but does not cover lower segment forced into an May be of the the top of the cervix uterus but does not abnormal birthing infringepositioncervicalos. on the in your uterus EFFECTS ON MOTHER May be born too May feel worried and early, and his lungs scared. may not function May increase your POOR PROGNOSIS properly. risk for blood clotting. vaginal bleeding If treated and managedred bleeding Profuse bright Painless If the baby is born too Avoidance of sexual May havenot treated andearly, he may have If vaginal managed COMA intercourse and vaginal bleeding that cannot bleeding medical HYPOVOLEMIC SHOCK serious Death of mother and Profused examination be stopped or fetus Hypotensionproblems, and he GOOD checkups Frequent PROGNOSIS controlled Partial Placenta The placenta partially covers the top of the cervix