Q&A: Placenta Abruption & Previa

Q&A: Placenta Abruption & Previa

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• A nurse is caring for a 38-week pregnant client. The

client is complaining of severe abdominal pain. What is your priority assessment?

• Check the contraction pattern
• Call for epidural orders
• Check for bleeding
• Assess fetal heart tones
• Assess fetal heart tones (CORRECT)

The priority is to check the fetal status so that we can know if the fetus is stable.This mom is showing signs of either a placental abruption or uterine infection, so we are concerned with the status of the fetus. We need to assess fetal stability to know if intervention is required.Check for bleeding There is no indication that the patient would be bleeding. Severe abdominal pain in pregnancy could be a symptom of placental abruption or infection. Our priority assessment would be to check fetal heart tones because that is our second patient and if the fetus is not stable then we need to know to intervene.Check the contraction pattern This patient has severe abdominal pain which is the main symptom of placental abruption or severe infection. The priority assessment is to assess the fetal status.Call for epidural orders We need to first assess the fetal heart tones to determine the status/stability of the fetus.

• A nurse is assessing a pregnant client who is in labor.

Which of the following symptoms would be indicative of a possible placental abruption?Select all that apply.

• Hypertension
• Maternal bradycardia
• Non reassuring FHR
• Abdominal pain
• Bleeding
• Bleeding

Bleeding occurs from the placenta being pulled from the uterus and leaving an open wound.

• Non reassuring FHR

FHR is non-reassuring because the placenta that brings oxygen and nutrients from the mother becomes detached.

• Abdominal pain

Severe abdominal pains from the placenta being ripped away from the uterus and blood filling up the uterus.

INCORRECT

Maternal bradycardia Maternal TACHYCARDIA would occur if shock symptoms start from blood loss.Hypertension This is not a symptom. It is more likely we would see HYPOTENSION due to blood loss.

• A nurse is assessing a postpartum client who delivered

via c-section for a placental abruption. What assessment finding would be the MOST concerning?

• Oozing from the IV site
• Abdominal cramping
• IV fluids running at 125 ml/hr
• Vaginal bleeding
• Oozing from the IV site (correct)

This is a major concern because of DIC, you bleed out of every orifice.Placental abduction puts a client at higher risk for DIC.IV fluids running at 125 ml/hr This is a normal post surgery. It would only be a concern if there was evidence this doesn't match the order or if the client is in heart failure.Abdominal cramping This is normal post delivery, the uterus is contracting to go back to pre pregnancy state.Vaginal bleeding Vaginal bleeding occurs after delivery as a normal finding. This is called lochia. It would be concerning if there was evidence of excessive bleeding, like saturating a pad every 15 minutes.

• A 40-week pregnant client arrives to the L&D unit in

labor. She admits to using cocaine this morning. The nurse knows this places the client at higher risk for which condition?

• Placental abruption
• Prolonged labor
• Placenta previa
• Miscarriage
• Placental abruption

Cocaine can cause a quick RISE in blood pressure and can cause placental abruption.Prolonged labor Precipitous delivery is the risk for cocaine use, which is a quick fast labor.Miscarriage At 40 weeks, cocaine is going to put the client at risk for abruption.Placenta previa Previa is when the placenta is located in the wrong spot and wouldn’t occur from cocaine use.

• A 32-week pregnant client arrives to the emergency

department with severe abdominal pain and vaginal bleeding. What condition should the nurse be concerned for?

• Miscarriage
• Cervical effacement
• Placental abruption
• Placenta previa
• Placental abruption (correct)

In the 3rd trimester, painful bleeding is indicative of possible placental abruption.Placenta previa This would be painless bleeding.Cervical effacement Effacement can cause some spotting but wouldn’t be painful.Miscarriage A miscarriage would happen earlier in pregnancy.Which of the following is an intervention for a stable fetus in a placenta previa pregnancy?

• Observation
• Multiple Rectal Examinations
• Multiple Vaginal Examinations
• Kegel Exercises
• Immediate Surgery
• Weight Bearing Exercises
• Observation

Close observation will be initiated to monitor blood loss, uterine tenderness, fetal activity, and vital signs. An external electronic fetal monitoring device may be applied to assess maternal and fetal heart rate. No vaginal or rectal exams are performed (pelvic rest - nothing in vagina).For a placenta previa pregnancy with a stable fetus, which position, movement or direction advised for the mother?

• Activity at Tolerated
• Pelvic Tilt Exercise
• Bed Rest
• Exercise
• Elevate Legs
• Fowlers Position
• Bed Rest

Bed rest will be recommended as walking and other movements can induce contractions. A side lying position is ideal as this reduces the pressure of the uterus on the inferior vena cava and improves blood flow.C-Section delivery is an intervention for which of the following?

• Baby is in Occiput Posterior Position
• Hemorrhage
• Unstable Fetus
• Preterm Labor Contractions
• Baby is in Occiput Anterior Position
• Stable Fetus
• Unstable Fetus

Excessive bleeding disrupts the uteroplacental blood flow, resulting in progressive deterioration of fetal status. A mature fetus (usually over 36 weeks gestation) should be prepared for immediate delivery.Which of the following is most likely indicated in a placenta previa pregnancy with an unstable fetus?

• C-section Delivery
• Vaginal Delivery Only
• Observation
• Moderate Exercise
• Cervical Cerclage
• Multiple Vaginal Examinations
• C-section Delivery

Cesarean delivery is necessary in practically all women with placenta previa as the placenta is at the cervix, and labor with cervical dilation could result in placental hemorrhage. Vaginal delivery may be attempted if a minor placenta previa of 2-3 cm from the cervical os is present, and one could proceed with an emergency cesarean if necessary.

During your assessment of a patient with Placenta Previa, which of the following is a sign or symptom that is most likely to be seen?

• Dark Red/Brown Vaginal Bleeding
• Absent Bowel Sounds
• Bright Red Vaginal Bleeding
• No Vaginal Bleeding
• Boggy Uterus
• Absence of Hegar's Sign
• Bright Red Vaginal Bleeding

Bright red vaginal bleeding, usually near the end of the 2nd trimester or in the 3rd trimester of pregnancy, occurs due to placental separation from the internal cervical os or lower uterine segment and the inability of the uterus to contract at the vessel sites. It can range from light to heavy bleeding, and a vaginal exam is contraindicated as this can result in dislodgment of the placenta from maternal tissues.Which of the following is most likely associated with Placenta Previa?

• Placenta adheres directly to myometrium
• Uteroplacental Insufficiency
• Placenta Covers Cervical Os
• Decreased Uteroplacental Perfusion
• Premature Separation of Placenta
• Retained Placenta
• Placenta Covers Cervical Os

Placenta previa occurs when the placenta covers the cervical os. The four classifications include: total (placenta completely covers the internal cervical os), partial (placenta partially covers the internal cervical os), marginal (placenta is at the margin of the internal cervical os), and low-lying placenta (placenta is implanted in the lower uterine segment in close proximity to the internal cervical os).Which of the following medications most likely may be used as an intervention for placenta previa?

• Misoprostol
• Magnesium Sulfate
• Oxytocin (Pitocin)
• Calcium Gluconate
• IV K+ Infusion at 5-10 mEq/hr
• Dinoprostone
• Magnesium Sulfate

Tocolytic drugs, such as magnesium sulfate, are medications that slow down or inhibit labor. In some cases, these may be given to the mother to promote the time for expectant management of symptomatic placenta previa Which of the following is a consideration most likely associated with placenta previa?

• Increased Risk Hemorrhagic Stroke
• Risk for Shock
• Increased Risk of Thrombosis
• Increased Risk of Endometrial Cancer
• Increased Risk of Seizure
• Smoking Increases Risk
• Risk for Shock

Excessive bleeding places the mother at risk for hypovolemic shock. Monitor vital signs for increased pulse and respiratory rate and falling blood pressure every 5-15 minutes if active bleeding. Maintain IV access with a large-bore IV for a blood transfusion if needed.During your assessment of a patient with Placenta Previa, which of the following is a sign or symptom that is most likely to be seen?

• Foul smelling greenish frothy discharge
• Painless
• Increased Deep Tendon Reflexes (DTRs)
• Pain
• Decreased Deep Tendon Reflexes (DTRS)
• Leg Muscle Cramps
• Painless

The classic presentation of a placenta previa is painless uterine bleeding.