Placenta previa is a condition in pregnancy characterized by the implantation of the placenta in the lower part of the uterus covering a part or all of the opening of the cervix. This condition can result in bleeding during pregnancy or during the delivery of the baby.
The placenta provides the growing fetus with nutrients and oxygen from the mother’s blood supply during pregnancy. It usually grows into the upper part of the uterus and stays there until the baby is born. After delivery, the placenta will separate from the uterine wall and is pushed out from the uterus. This is referred to as afterbirth.
Risk factors for placenta previa include:
- Advanced maternal age
- Scarring in the uterus due to previous surgery
- Previous C-section delivery
- Cocaine use
Many patients with placenta previa have no symptoms. Placenta previa is usually found during a routine ultrasound. If symptoms do occur, it is usually painless vaginal bleeding during the second or third trimester.
Complications of placenta previa include hemorrhage, fetal distress, shock from blood loss for the mother and baby, preterm labor and delivery, emergency cesarean delivery, and death.
The Nursing Process
Placenta previa management includes interventions that prolong the pregnancy and prevent bleeding. Hospitalization may be required for close monitoring along with the administration of medications that help prevent early labor. Cesarean delivery is often indicated to reduce bleeding.
Nurses play a critical part in supporting women with placenta previa as they provide education, examinations, and medical interventions to prevent maternal and fetal mortality.
Nursing Care Plans Related to Placenta Previa
Risk for Bleeding Care Plan
Pregnant women with placenta previa are at risk for bleeding and require monitoring and education on preventing bleeding.
Nursing Diagnosis: Risk for Bleeding
- Disease process
- Low-lying placenta
- Sexual intercourse
- Vaginal examinations
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet and nursing interventions are directed at the prevention of symptoms.
- The patient discusses and demonstrates precautions to prevent bleeding complications
- The patient is able to deliver the fetus without excessive bleeding
Risk for Bleeding Assessment
1. Assess vital signs.
Increased pulse rate and decreased blood pressure can signal bleeding. Vital signs should be closely monitored with placenta previa.
2. Assess and monitor diagnostic studies.
Transabdominal or transvaginal ultrasounds should be conducted to monitor the location of the placenta.
3. Assess coagulation studies.
Closely monitor PTT and hemoglobin levels for possible bleeding risks.
Risk for Bleeding Interventions
1. Type and cross.
To prepare for possible bleeding, ensure the patient is type and crossed for potential blood transfusions.
2. Administer blood transfusions as indicated.
A blood transfusion may be indicated for patients with placenta previa who have active heavy bleeding.
3. Educate on preventing bleeding.
Teach the patient that sexual intercourse or vaginal penetration can provoke bleeding. Instruct not to partake in strenuous activity or lift over 20 pounds.
4. Prepare the patient for Cesarean section.
Patients with placenta previa will usually require Cesarean section delivery at 36-37 weeks. Prepare the patient for what to expect pre and post-operatively.
Impaired Physical Mobility Care Plan
The American College of Obstetricians and Gynecologists (ACOG) does not recommend bed rest in most instances, but reduced activity and lifestyle changes may be required.
Nursing Diagnosis: Impaired Physical Mobility
- Activity restrictions
- Disease process
- Increased risk for bleeding
As evidenced by:
- Medical protocol requiring reduced activity
- The patient will verbalize understanding and adhere to the prescribed activity restrictions
- The patient will prevent loss of muscle strength and endurance during bed rest
Impaired Physical Mobility Assessment
1. Assess usual activity levels.
Assess the patient’s current exercise and activity levels. Those who partake in strenuous exercise or weight-lifting will likely require reduced activity until after delivery.
2. Assess for a support system.
If bed rest or activity restrictions are instituted the mother may require help with other children or responsibilities. Assess for the presence of a partner or family member that can help.
Impaired Physical Mobility Interventions
1. Educate on the importance of reduced activity.
Reduced activity places less pressure on the cervix and may help the placenta function better to deliver nutrients and oxygen to the fetus.
2. Instruct on specific restrictions.
Complete bed rest is often not required. If it is, teach the mother that they should only partake in minimal activities such as walking to the bathroom, sitting at a desk, and standing or walking for less than 20 minutes.
3. Educate on other activities to maintain muscle strength.
Patients can usually partake in stretching of the extremities while in bed or other activities that promote circulation. Always discuss with a doctor first.
4. Left side-lying is recommended.
Lying on the left side is generally recommended during pregnancy to maximize blood flow to the uterus.
Situational Low Self-Esteem Care Plan
Pregnancy can be an emotional time and this can be aggravated when there are complications. Pregnant women diagnosed with placenta previa may feel stressed or anxious upon confirmation of diagnosis and may feel guilt that they did something wrong to contribute to their condition, especially if fetal or maternal harm occurs.
Nursing Diagnosis: Situational Low Self-Esteem
- Change in health status
- Situational crisis
As evidenced by:
- Expresses helplessness
- Self-negating verbalizations
- Underestimates ability to deal with the situation
- Expresses guilt or shame
- The patient will verbalize acceptance of the diagnosis and a positive outlook
- The patient will adhere to the treatment plan to reduce risks to self and fetus
Situational Low Self-Esteem Assessment
1. Assess for any signs of depression.
Pregnancy itself can cause feelings of depression, especially if the patient has a history. Threats to the patient’s health as well as their fetus can increase these feelings.
2. Assess for thoughts of low self-esteem.
Assess how the patient is feeling in regards to their self-worth and if they place any blame on themselves for their diagnosis.
Situational Low Self-Esteem Interventions
1. Help the patient focus on what they can control.
The patient may not be able to control the position of the placenta but they can be taught lifestyle modifications to prevent bleeding and preterm labor.
2. Educate the patient about the causes of placenta previa.
Often there is no cause for placenta previa or causes can be vague. Maternal age over 35 can be a contributor as well as simply being pregnant before. A past surgical procedure such as D&C which is often done after a miscarriage or abortion is a risk factor and may cause unnecessary feelings of guilt to the mother. Educate them that they are not to blame.
3. Provide emotional and psychological support.
Allow the patient to verbalize feelings and concerns about the current situation. Listen and remain nonjudgmental. Provide support and reassurance that the medical team is providing excellent care to prevent complications and ensure a safe delivery.
4. Refer the patient to support groups.
Knowing that she is not alone and that other pregnant women have gotten through this condition can help the mother cope with her pregnancy and delivery.
References and Sources
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Placenta Previa. Anderson-Bagga FM, Sze A. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539818/
- Placenta previa. Mayo Clinic. Updated May 11, 2022. From: https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768
- Placenta Previa. Reviewed by Arefa Cassoobhoy, MD, MPH. WebMD. Updated July 28, 2020. From: https://www.webmd.com/baby/guide/what-is-placenta-previa
- Placenta Previa. Ronan Bakker, MD. Medscape. Updated: Jan 08, 2018. From: https://emedicine.medscape.com/article/262063-overview