ACTIVE LEARNING TEMPLATE: System Disorder
STUDENT NAME
DISORDER/DISEASE PROCESS
Placenta Previa
REVIEW MODULE CHAPTER
Alterations In Health (Diagnosis)
Pathophysiology Related To Client Problem
Health Promotion And Disease Prevention
ASSESSMENT
SAFETY CONSIDERATIONS
Risk Factors
Expected Findings
Laboratory Tests
Diagnostic Procedures
PATIENT-CENTERED CARE
placenta previa (please fill in every box)
The Correct Answer And Explanation is:
ACTIVE LEARNING TEMPLATE: System Disorder
STUDENT NAME: (Your name here)
DISORDER/DISEASE PROCESS: Placenta Previa
REVIEW MODULE CHAPTER: Maternal Newborn Nursing – Chapter: Hemorrhagic Conditions in Pregnancy
ALTERATIONS IN HEALTH (DIAGNOSIS)
Placenta previa is a condition where the placenta implants in the lower uterine segment, partially or completely covering the cervical os. This abnormal implantation can cause significant bleeding during pregnancy and delivery.
PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM
In placenta previa, the placenta develops in the lower part of the uterus, rather than the upper segment. As the uterus grows and the cervix begins to efface and dilate in the third trimester, the placental blood vessels may rupture, leading to painless, bright red vaginal bleeding. The exact cause is unknown, but uterine scarring or abnormalities in placental implantation are often contributing factors.
HEALTH PROMOTION AND DISEASE PREVENTION
- Encourage women to attend regular prenatal visits and report any vaginal bleeding.
- Educate clients on the importance of avoiding smoking and illicit drug use.
- Promote adequate spacing between pregnancies and discuss risks of multiple cesarean sections, which increase placenta previa risk.
- Advise women with prior placenta previa or uterine surgery to seek early ultrasound for placental location.
ASSESSMENT
SAFETY CONSIDERATIONS
- Avoid vaginal exams if placenta previa is suspected, as this may trigger hemorrhage.
- Ensure IV access for fluid resuscitation.
- Prepare for possible cesarean delivery.
- Monitor for signs of hypovolemic shock.
RISK FACTORS
- Previous placenta previa
- Uterine scarring (e.g., prior C-section or curettage)
- Advanced maternal age (>35 years)
- Smoking
- Multiple gestation
- Multiparity
EXPECTED FINDINGS
- Painless, bright red vaginal bleeding (usually after 20 weeks)
- Soft, non-tender uterus
- Fundal height greater than expected for gestational age
- Malpresentation (e.g., breech or transverse)
LABORATORY TESTS
- CBC to assess for anemia
- Blood type and crossmatch
- Coagulation profile
- Kleihauer-Betke test (to determine fetal-maternal hemorrhage)
DIAGNOSTIC PROCEDURES
- Transabdominal or transvaginal ultrasound to confirm placental location
- Fetal monitoring to assess fetal well-being
PATIENT-CENTERED CARE
- Instruct the client on pelvic rest (no intercourse, douching, or vaginal exams).
- Encourage bed rest or limited activity depending on severity and gestational age.
- Administer corticosteroids if preterm birth is anticipated to enhance fetal lung maturity.
- Prepare the client for possible cesarean delivery if the placenta does not migrate away from the cervix.
- Provide emotional support, especially in cases requiring prolonged hospitalization or early delivery.
- Educate about signs to report, including bleeding, contractions, or decreased fetal movement.
300+ WORD EXPLANATION
Placenta previa is a serious pregnancy complication in which the placenta is located abnormally low in the uterus, partially or fully covering the cervix. This condition can lead to significant maternal and fetal risks, particularly as the pregnancy progresses into the third trimester. The placenta typically implants in the upper posterior uterine wall, but in placenta previa, it is displaced toward the lower uterine segment, which can interfere with normal labor and delivery.
The hallmark symptom is painless, bright red vaginal bleeding, usually after 20 weeks of gestation. Unlike placental abruption, which causes painful bleeding, placenta previa is not typically associated with uterine tenderness or contractions. The exact cause is unknown, but risk factors include a history of cesarean section, uterine surgeries, high parity, smoking, and advanced maternal age.
Diagnosis is confirmed using ultrasound, either transabdominal or transvaginal, with transvaginal being more accurate and safe when performed by experienced providers. Vaginal examinations should be avoided unless placenta previa is ruled out, as they can cause massive hemorrhage.
Management depends on the severity of the condition and gestational age. If bleeding is minimal and the fetus is preterm, conservative management may include hospitalization, bed rest, and close monitoring. Corticosteroids may be administered to promote fetal lung maturity if early delivery is anticipated. If the bleeding is severe or if the placenta still covers the cervix near term, cesarean delivery is usually indicated.
Patient-centered care includes emotional support, activity restriction, and clear education on signs of worsening symptoms. Preventive strategies involve avoiding risk factors like smoking and multiple uterine surgeries. Through vigilant monitoring and collaborative care, both maternal and fetal outcomes can be optimized in placenta previa cases.