At the end of the presentation of the case study, the students will be able to:

Understand what Placenta Previa is.

Describe the types, etiology, risk factors contributing to the cause of Placenta Previa.
Learn what are the signs and symptoms and possible complications of Placenta Previa.
Describe and understand the general medical and surgical management, pharmacologic
management, and as well as the nursing responsibilities for patients with Placenta Previa.
Understand the anatomy and physiology of placenta.
Discuss the general and specific pathophysiology of Placenta Previa.
Understand the patients health history, patterns of functioning, levels of competencies,
and developmental tasks and relate this on the contribution or development to the
patients condition.
Discuss the specific medical management done to the patient and as well as the nursing
management appropriate to the patients condition.
Identify the drugs given to the patient, understand its mode of action, and provide
appropriate nursing interventions in relation to the drug to ensure patients safety and to
potentiate the effect of the drug.
Identify nursing diagnosis appropriate to the patient and discuss nursing care plans to
provide holistic care to the patient.
We have chosen this case to be studied and to be presented
because:
It is a rare case and we want to enhance our knowledge about
this case.
One of the causes of mortality and morbidity during 3rd
trimester of pregnancy.
 Is a condition of pregnancy in which the placenta is
implanted abnormally in the uterus. It is the most common
cause of painless vaginal bleeding in the third trimester of
pregnancy.
 LOW-LYING OR MARGINAL PLACENTA PREVIA
-Low-lying placenta is near the cervical opening but not
covering it. It will often move upward in the uterus as your
due date approaches. (30%)
-mode of delivery: NSD
PARTIAL PLACENTA PREVIA
-an implantation that occludes a portion of the cervical os
(70%)
-mode of delivery: CS
COMPLETE/TOTALIS PLACENTA PREVIA
-totally obstructs or totally covered the cervical os (100%)
-mode of delivery: CS
 Exact etiology of placenta previa is unknown. It is hypothesized
to be related to abnormal vascularization of the endometrium
caused by scarring or atrophy from previous trauma, surgery, or
infection. These factors may reduce differential growth of lower
segment, resulting in less upward shift in placental position as
pregnancy advances.
PROGNOSIS:
The majority of women with placenta previa in developed
countries will deliver healthy babies, and the maternal mortality
(death) rate is less than 1%. In developing countries where
medical resources may be lacking, the risks for mother and fetus
may be higher.
MODIFIABLE FACTORS:
Lifestyle
Illicit drugs or cocaine use
Smoking
Alcoholism

NON-MODIFIABLE FACTORS:
Age (older than 35 years old and younger than 20 years old)
Race is a controversial risk factor, with some studies finding that people from
Asia and Africa are at higher risk and others finding no difference.
Previous CS
Increased parity (80%)
Prior to abortion and past uterine curettage
Multiple gestation
Congenital anomalies
Heredity
Previous placenta previa
 Painless vaginal bleeding during 1st trimester; bright red in
color associated with stretching and thinning of the lower uterine
segment that occurs in 3rd trimester.
Decreasing urinary output.
Medium to severe vaginal bleeding during first trimester.
Symptoms of early labor, such as regular contractions and
aches or pains in lower back or belly.
 DIAGNOSTIC
EXAMINATIONS
DESCRIPTION:
Ultrasound is a painless test that uses sound waves to create images of
organs and structures inside your body. It is a very common used test. As it uses
sound waves and not radiation, it is not thought to be harmless.
An ultrasound examination is used to establish the diagnosis of
placenta previa. Either a transabdominal (using a probe on the abdominal wall)
or transvaginal (with a probe inserted inside the vagina but away from the
cervical opening) ultrasound evaluation may be performed, depending upon
the location of the placenta. Sometimes both types of ultrasound examination
are necessary

PURPOSES
To know, fetal and pregnancy abnormalities.
To know the amount of amniotic fluid and fetal position.
Doctor may order an ultrasound if you are experiencing pain, swelling, or
other symptoms that require an internal view of your organs.
1. The client will change into a hospital gown.
2. The client will most likely be lying down on a table with a section of
the body exposed for the test.
3. An ultrasound technician, called a sonographer, will apply a special
lubricating jelly to the area of the skin.
4. The transducer sends high-frequency sound waves through the body.
5. The waves echo as they hit a dense object, such as an organ or
bone. Those echoes are then reflected back into a computer.
6. The sound waves are at too high of a pitch for the human ear to
hear. Depending on the area being examined, you may need to
change positions so the technician can have better access.
7. After the procedure, the gel will be cleaned off abdomen. The
whole procedure typically lasts less than 30 minutes.
NURSING RESPONSIBILITIES:
Explain the procedure is painless and safe and that no
radiation exposure is involved.
Emphasized the importance of remaining still during the scan to
prevent distorted image.
Assist the patient into a supine position; if possible use pillows to
support the area to be examined. Put a water soluble jelly to
the target area.
NORMAL FINDINGS
Normal result: Placental implantation visualized in fundus of
uterus.
Abnormality with condition: Placental implantation visualized
in lower uterine segment.
Explanation: visualization of placenta determines location
and can rule out other causes of bleeding.
 A small tube placed inside the vagina to look for the
uterus its usually show how close the placenta in the edge or top
of the cervix. It is beneficial for those patients with posterior
placenta previa because of increased clarity of diagnosis,
decreased time of scanning, and no increased incidence of
hemorrhage.
TRANSABDOMINAL ULTRASOUND
A small device use to show the picture of the uterus, it is
usually done in full bladder test.

DOPPLER ULTRASOUND
A Doppler ultrasound usually done to check if the placenta
has grown into the wall of the uterus.
 LABORATORY
EXAMINATIONS
Description:
A Complete Blood Count (CBC), also known as Full Blood
Count (FBC) or Full Blood Exams (FBE) or blood panel, is a test
panel requested by a doctor or other medical professional that
gives information about the cells in a patients blood.

Purpose:
This test was done to evaluate overall health and detect a wide
range of disorders, including anemia or presence of infection.
Routine laboratory examination.
Procedures:
The patient is usually assigned in sitting position with the left or right
hand stretch on a platform or table with the palm facing upward.
A venipuncture site will be chosen on where to get the blood
specimen.
A tourniquet is applied around the arm.
The skin overlying the vein will be cleaned using cotton and an
antiseptic.
A needle is inserted through the area of cleansed skin into the vein
below where the tourniquet is applied.
Blood is pulled from the vein via the needle by gently pulling the
plunger of the syringe.
After that, tourniquet is removed to facilitate venous return.
A dry cotton ball is taped in the insertion site upon the removal of the
needle.
The blood sample is then sent to the laboratory for analysis.
Nursing Responsibilities:
Check doctors order.
Explain the procedure to the patient and its rationale.
Use aseptic technique by cleansing the venipuncture site with
cotton and alcohol.
Inform patient what he/she may feel.
There are no food, fluid, or medication restrictions unless by
medical direction.
Evaluate the venipuncture site and pressure if there is continuous
bleeding.
Report any result to the requesting HCP, who will discuss the
results with the patient.
EXAMINATION NORMAL VALUES
Hemoglobin F: 12-16 g/dl
M: 13.8-18 g/dl
Hematocrit F: 36-46%
M: 37-49%
WBC 5.0- 10.0
Neutrophils 40- 60%
Lymphocytes 20-40%
Monocytes 2-6%
Eosinophils 1-3%
Basophils 0-2%

Platelet Count 150- 450 x 10/ L

Description:
Blood typing is a method to tell what specific type of blood you
have. To determine the blood type of the patient
To check compatibility of the donor and the patient before
blood transfusion, in case severe blood loss during surgery.

Blood is often grouped according to the ABO blood typing

system. This method breaks blood types down into four categories:
Type A
Type B
Type AB
Type O
PROCEDURES:
Blood is drawn from a vein, usually from the inside of the elbow
or the antecubital area.
The puncture site is cleaned with an antiseptic solution.
An elastic band is placed around the upper arm to apply
pressure, which causes the vein to swell with blood.
A needle is inserted into the vein, and the blood is collected into
a tube.
During the procedure, the elastic band is removed to restore
circulation.
Once the blood has been collected, the needle is removed, and
a band-aid or gauze is applied.
 NURSING RESPONSIBILITIES:
Explain the procedure to the patient and its rationale.
Use aseptic technique by cleansing the venipuncture site with
cotton and alcohol.
Evaluate the venipuncture site and pressure if there is continuous
bleeding.
Report any result to the requesting HCP, who will discuss the
results with the patient.
 Monitor maternal vital signs and fetal heart tone.
Administer IVF as ordered.
Oxygen therapy as ordered.
Complete bed rest.
Left lateral position
Delivery of viable neonate.
With fetus of less than 36 weeks gestation, careful observation
to determine safety of continuing pregnancy or need for
preterm delivery.
 It essential when clients are unable to take food and fluid
orally.
It is an efficient and effective method of supplying fluids
directly into the intravascular fluid compartment and replacing
electrolyte losses.
IVF therapy is usually ordered by the physician.
 ISOTONIC SOLUTION- having the same concentration of solutes
as blood plasma. Isotonic solutions are often used to restore
vascular volume.

HYPERTONIC SOLUTION- has a greater concentration of

solutes than plasma.

HYPOTONIC SOLUTION- has a lesser concentration of solutes.

PURPOSES:
Used to maintain the patients hydration.
Serves as a route for medication.

NURSING MANAGEMENT:
Verify the Doctors order.
Inform the client and explain the purpose of IV therapy.
Instruct the patient that the procedure may cause a little bit
pain upon insertion.
Practice aseptic technique.
Regulate IVF at prescribed rate.
Check IV patency.
Observe for potential complications.
 TYPE PURPOSE NSG. RESPONSIBILITIES

ISOTONIC SOLUTIONS
-0.9% NaCl (normal -NS and lactated Ringers -Caution must be exercised in the
saline) initially remain in the vascular administration of parenteral fluids.
compartment, expanding -Assess clients carefully for signs of
-Lactated Ringers (a vascular volume. hypervolemia such as bounding
balanced electrolyte pulse and shortness of breath.
solution)

-5% dextrose in water -D5W on initial administration -D5W is avoided in clients at risk for
(D5W) but provides free water when increased intracranial pressure (IICP)
dextrose is metabolized, because it can increase cerebral
expanding intracellular and edema.
extracellular fluid volumes.
 TYPE PURPOSE NSG. RESPONSIBILITIES

HYPOTONIC SOLUTION
-0.45% NaCl (half -Hypotonic solutions are -Caution must be exercised in the
normal saline) used to provide free water administration of parenteral
and treat cellular fluids
-0.33% NaCl (one-third dehydration. These solutions -Do not administer to clients at
normal sline) promote waste elimination risk for IICP or third-space fluid
by the kidneys. shift.
 TYPE PURPOSE NSG. RESPONSIBILITIES

HYPERTONIC SOLUTION
-5% dextrose in normal -Hypertonic solutions draw -Caution must be exercised in the
saline (D5NS) fluid out of the intracellular administration of parenteral
and interstitial compartments fluids
-5% dextrose in 0.45% into the vascular compartment, -Do not administer to clients with
NaCl (D5 1/2NS) expanding vascular volume. kidney or heart disease or clients
who are dehydrated.
-5% dextrose in lactated -For persons needing extra -Watch for signs of
Ringers (D5LR) calories who cannot tolerate hypervolemia.
fluid overload. -Solution containing dextrose
should be used with caution.
-Discard unused portion
PHARMACOLOGIC
MANAGEMENT
 BETAMETHASONE (CELESTONE)
Steroids may be given if patient need to deliver her
baby earlier than expected. These medicines help the baby's
lungs to mature and prevent breathing problems after he is
born.
REPRESENTATIVE DRUGS
Generic name:
BETAMETHASONE
Brand name:
CELESTONE
CLASSIFICATION(S):
Therapeutic: corticosteroids
Pharmacologic:
Corticosteroids (systemic)
Pregnancy Category C
(prednisolone)
Route and Dosage:
>PO(Adults): 0.6mg-7.2 mg/dy
as a single daily dose or in
divided doses
>IM, IV (Adults): Up to 9 mg of
betamethasone sodium phosphate
or 0.5-9 mg IM as betamethasone
sodium phosphate/acetate
suspension. Prevention of
respiratory distress syndrome in
newborn- 12 mg 12 daily for 2-3
days before delivery (unlabeled).
THERAPEUTIC
ACTIONS
>In pharmacologic does, all
agents suppress
inflammation and the normal
immune response.
>all agents have numerous
intense metabolic effects.
>suppress adrenal function at
chronic doses of
betamethasone---0.6 mg/day.
>have negligible
mineralocorticoid activity.
Therapeutic Effects:
-suppression of inflammation
and modification of the
normal immune response
-replacement therapy in
adrenal insufficiency
INDICATIONS
>used systemically and
locally in a wide variety of
chronic diseases including:
-inflammatory
-allergic
-hematologic
-neoplastic
-autoimmune disorders
-with other
-immunosuppressants in the
prevention of organ rejection
in transplantation surgery
ADVERSE NURSING RESPONSIBILITY
REACTIONS AND SIDE
EFFECTS
Adverse reactions/side effects >Assess involved systems before
are much more common with
high-dose/long-term therapy. and periodically during therapy.
CNS:
>Assess pt. for signs of adrenal
Depression, euphoria,
headache, increased insuffiency before and
intracranial pressure (children
only), personality changes, periodically during therapy.
psychoses, restlessness
>monitor intake and output.
EENT:
Cataracts, increased intraocular >observe for peripheral edema,
pressure
CV: steady weight gain and dyspnea.
Hypertension
>notify physician or other health
GI:
Peptic ulceration, anorexia, professional if these occur.
nausea, vomiting,
DERM:
Acne, decreased wound
healing, ecchymoses, fragility,
petichiae
ENDO:
Adrenal suppression,
hyperglycemia
F and E:
Fluid retension(long-term high
doses), hypokalemia,
hypokalemic alkalosis
HEMAT: thromboembolism,
thrombophlebitis
METAB:
Weight gain, weight loss
MS:
Muscle wasting, osteoporosis,
aseptic necrosis of joints, muscle
pain
 Tocolytics are medicines that attempt to stop labor. They are
used if labor begins before term. Tocolytics can stop labor or delay
labor to give the baby's lungs time to mature. If started early in
premature labor, they may be effective. They are not as successful
later in labor, if the membranes have broken, or if your cervix is
already dilated beyond 2 centimeters. When taking this medication,
you may need hospitalization or home therapy.

MAGNESIUM SULFATE
This medicine can be used to stop contractions as well as in
the treatment and prevention of seizures in a patient with
preeclampsia. It can be taken as a pill or through an IV.
REPRESENTATIVE DRUGS THERAPEUTIC INDICATIONS ADVERSE NURSING
ACTIONS REACTIONS RESPONSIBILITY
AND SIDE
EFFECTS
MAGNESIUM SULFATE [IV] (9.9% >Essential for the >Treatment/prevention of CNS: drowsiness >Explain purposes of
Mg; 8.1 mEq Mg/g) activity of many hypomagnesemia RESP: decreased medication to patient and
CLASSIFICATION(S): enzymes >Anticonvulsant in severe respiratory rate family
Mineral and electrolyte >Plays an important eclampsia or CV: arrhythmias, >monitor maternal vital
replacements/supplements role in preeclampsia bradycardia, signs and fetal heart rate
neurotransmission >unlabeled uses: hypotension >assess for deep tendon
PHARMACOLOGIC: and muscular -preterm labor GI: diarrhea reflex
Minerals/electrolytes excitability -treatment of Torsades de DERM: flushing, >check for LOC
Pregnancy Category D Therapeutic effects: pointes sweating
Route and Dosage: -Replacement in METAB:
>IM (Adults): severe deficiency- deficiency states hypothermia
250 mg/kg over 4 hr; mild -Resolution of Magnesium
deficiency-1 g q 6 hr for 4 doses. eclampsia sulfate can
>IV (Adults): severe deficiency-5g. affect
reflexes.
 TERBUTALINE (BRETHINE)
Acts directly on beta2-receptors to relax uterine contractions.
This medicine is used to stop preterm labor. It is also known as
Brethine. It can be taken as a pill, through an IV (through a
catheter directly into your vein), as an injection, or through a
controlled infusion pump. A pump is used to give a continuous low
dose of the terbutaline. Additional amounts of the medication can
be administered if uterine activity increases.
REPRESENTATIVE DRUGS THERAPEUTIC INDICATIONS ADVERSE NURSING
ACTIONS REACTIONS AND SIDE RESPONSIBILITY
EFFECTS

Generic name: >Result in the >Management of CNS: nervousness, >Explain purposes

TERBUTALINE accumulation of reversible airway restlessness, tremor, of medication to
(BRETHINE) cyclic adenosine disease due to headache, insomnia patient and family
monophosphate asthma or COPD; RESP: paradoxical >assess lung sounds,
CLASSIFICATION(S): (cAMP) at beta- inhalation and subcut bronchospasm respiratory pattern,
Therapeutic: adrenergic receptors used for short-term (excessive use of pulse and blood
bronchodilators >Produces control and oral inhalers) pressure before
Pharmacologic: bronchodilation agent as long-term CV: angina, administrations and
adrenergics >inhibits the release control. arrhythmias, during peak of
Pregnancy Category of mediators of >Unlabeled uses: hypertension, medication.
B immediate -Management of tachycardia >check for LOC
Route and Dosage: hypersensitivity preterm labor GI: nausea and
>Subcut (Adults): 20 mcg
reactions from mast (tocolytic). vomiting
once daily
cells ENDO:
:Pre-Filled pen delivery
Therapeutic effects: hyperglycemia
device (FORTEO pen):
delivers 20 mcg/day. Bronchodilation.
DESCRIPTION
These two types of anesthesia numb your body from the chest down to the legs.
The medication is placed directly into the spine area.
Spinal anesthesia (or spinal anesthesia), also called spinal analgesia, spinal
block or sub-arachnoid block (SAB), is a form of regional anesthesia
involving injection of a local anesthetic into the subarachnoid space,
generally through a fine needle, usually 9 cm long (3.5 inches). For extremely
obese patients longer needles are available (12.7 cm / 5 inches). The tip of
the spinal needle has a point or small bevel. Recently, pencil point needles
have been made available (Whitacre, Sprotte, Gertie Marx & others)
Epidural anesthesia is a technique whereby a local anesthetic drug is injected
through a catheter placed into the epidural space. This technique has some
similarity to spinal anesthesia
PURPOSES:
Spinal and epidural anesthesia is frequently given for surgeries
involving:
Pelvis, hips, and legs
Childbirth
Advantages of these types of anesthesia include:
The ability to be awake during the operation

POSSIBLE COMPLICATIONS:
Severe headache or back pain
Drop in blood pressure
Nerve damage
Infection
Allergic reaction to the anesthetic used
Longer labor during childbirth with an epidural anesthesia
PRIOR TO PROCEDURE:
Make sure that your doctor is aware of:
Your drug allergies
Medications you are taking
Any heart or lung conditions you have
Any previous reactions that you or other family
members have had to anesthesia
Any bleeding problems you have had in the past
PROCEDURE:
An area on your back above the spinal cord will be
cleaned.
A local anesthetic will be injected into the skin to numb the
area.
If you are getting spinal anesthesia, the doctor will give
you one injection.
The medication will be sent directly into the sac of fluid
that surrounds the spinal cord.
If you are getting epidural anesthesia, it may be delivered
the same way. But, if you need more than one dose, you
will have a tiny, flexible tube in place just outside of the
fluid sac. This allows the doctor to give you more
medication if you need it.
After the surgery, a bandage will be placed over the
injection spot.
NURSING RESPONSIBILITY:
Monitor vital signs.
Assess for level of consciousness.
Check for urine output.
Ensure safety.
SURGICAL MANAGEMENT
 A cesarean section is an operation that delivers a baby through
a cut in abdomen and uterus.
Cesarean birth happens through an incision in the abdominal
wall and uterus rather than through the vagina.
Cesarean delivery takes about 45 to 60 minutes. It takes place
in an operating room. So if you were in a labor and delivery
room, you will be moved to an operating room.

PURPOSE:
Surgical treatment for placenta previa to prevent further
blood loss that could occur with disruption of the placenta during
vaginal bleeding.
PREOPERATIVE
Verify the patients identity.
Obtain an informed consent.
Monitor maternal Vital signs and fetal heart tone.
Ensure cardio pulmonary clearance.
Perform hand hygiene and apply antiseptic or alcohol (70%).
Inform the patient of what is happening and provide support.
Position the patient for the skin preparation and placement of the indwelling catheter.
Insert the indwelling catheter and position the drain tube of the catheter under the
patients leg. If a catheter is already in place, confirm its patency and the colour and
amount of urine currently in the drainage bag, and then place the bag near the head of
the table.
Place the padding around the area of skin to be prepare for the incision to prevent the
pooling of solutions under the patient. This padding should be removed after preparation
is complete and before sterile drapes are applied.
Perform surgical counts of sponges, sharps, and instruments per institutional policy and
procedure. A count is conducted before the start of the procedure and before the closure
of the uterus, peritoneum, and skin incision. A count is also performed when a change in
surgical staff takes place.
Perform a sterile abdominal skin preparation.
Continue monitoring the FHR until abdominal sterile preparation has been started and
abdominal preparation is complete.
Alleviate patient anxiety
INTRAOPERATIVE:
Verify that all required documentation is completed.
Correct informed surgical consent, with patients signature.
Completed records for health history and physical examination.
Verify details, provide explanations, and answer questions to provide a sense of
professionalism and friendness that can help the patient feel secured.
Give attention to physical comfort of the client.
Inform the patient who else will be present in the OR, how long the procedure is expected
to take and other details that helps the patient prepare for the experience and gain a
sense of control.
Position patient according to the surgical procedure to be performed and as well as to the
physical condition of the patient.
Precautions for patient safety must observe particularly with thin, elderly, or obese
patients and those with physical deformities.
Monitor and manage potential complications that may occur.
Add additional sponges, sharps, and instrument to the operating room as requested. Count
additions with the scrub person and add them to the count sheet.
Bring any medication, fluids, or surgical supplies as requested to the operating field using
sterile technique.
Monitor conditions in the OR. Any break in sterile technique must be reported and
corrected.
Perform surgical counts of sponges, sharps, and instruments per institutional policy before
closure of the uterus, peritoneum, and skin incision. A count is also conducted when a
change in surgical staff takes place.
Notify the practitioner immediately if the surgical count is not correct.
POST-OPERTIVE
Monitor airway and level of consciousness.
Monitor vital signs every 15 minutes for the first 2 hours, and every 1 hour for the next 2 hours,
if stable, every shift.
Administer pain reliever as ordered.
Encourage also deep breathing exercise.
Check for complications of surgery. (e.g. Bleeding, haemorrhage, infection, wound dehiscence,
evisceration, palpable lymph nodes, increase WBC count, presence of malodorous vaginal
discharge, etc.)
Assess for signs and symptoms of respiratory depression and altered level of consciousness due
to effect of anesthesia.
Assess patients pain scale.
Promote relaxation techniques such as listening to music, diversion of activities, splinting, etc.
Verify whether the infant is being transferred to the nursery or will remain with the patient to be
cared for in a family-centered environment.
Check for skin integrity.
Maintain aseptic technique when dressing and caring wound.
Emphasize the importance of proper hand washing.
Administer antibiotics and analgesics as ordered.
Document the procedure in the patient's record.
 Monitor maternal vital signs and fetal heart tone.
Monitor patients condition and measure amount of vaginal bleeding.
Monitor patients intake and output. Weigh the patient daily. (Best
way to monitor I & O).
Monitor for presence of severe bleeding and for signs and symptoms
of shock (e.g. hypotension, tachycardia, tachypnea, etc.) and
evaluate changes.
Assess for patients capillary refill- to determine effective tissue
perfusion.
Monitor for signs and symptoms of fetal distress (e.g. decrease or
absence of FHT, bradycardia, tachycardia, late or available
decelerations, etc.)
Monitor laboratory results for signs and symptoms of infection (e.g.
elevated WBC count, presence of malodorous vaginal discharge, etc.)
Oxygen readily available at bedside. Administer oxygen as ordered.
 Administer IVF or blood transfusions as ordered.
Administer medications as ordered (Magnesium Sulfate, Tocolytics,
Corticosteroids,etc.)
Institute complete bed rest.
Position the patient at left lateral position.
If the patient is Rh negative, administer Rh (0) immune globulin
(RhoGAm) after every bleeding episode.
Provide information about labor progress and the condition of the
fetus.
Prepare the patient and her family for a possible cesarean section
delivery and the birth of a preterm neonate, and provide thorough
instructions for postpartum care.
Encourage the patient and her family to verbalize their feelings to
help reduce anxiety and develop effective coping strategies
Provide health teaching to the patient such as proper perineal
hygiene - to decrease the risk of ascending infection.
During the postpartum period, monitor the patient for signs of early
and late postpartum hemorrhage and shock.
 Fluid volume deficit r/t active blood loss secondary to disrupted placental
implantation.
Fear r/t threat to maternal and fetal survival secondary to excessive blood
loss.
Risk for impaired fetal gas exchange r/t disruption of placental
implantation.
Active blood loss (hemorrhage) r/t disrupted placental implantation.
Activity intolerance r/t enforced bed rest during pregnancy secondary to
potential for hemorrhage.
Altered diversional activity r/t inability to engage in usual activities
secondary to enforced bed rest and inactivity during pregnancy.
COMPLICATIONS FOR THE MATERNAL INCLUDE:
Antepartum hemorrhage
Malpresentation
hemorrhage
puerperal sepsis
Death

COMPLICATIONS FOR THE FETUS INCLUDE:

Problems for the baby secondary to acute blood loss.
Intrauterine growth retardation due to poor placental perfusion (15%
incidence)
Increased incidence of congenital anomalies
Premature delivery
Death