Care Plan For A Patient With Placenta Previa

Care Plan for a Patient with Placenta Previa

The placenta is an organ that develops in a woman's uterus during pregnancy. The placenta provides the growing fetus with nutrition and oxygen and removes waste from the womb (Bhide & Thilaganathan, 2019). It also serves as a way to connect the baby with the mother through the umbilical cord as it attaches at the side or the top of the uterus. Placenta previa is a complication that occurs when the placenta covers totally or partially the cervix. Placenta previa can be life-threatening since it causes excessive bleeding during delivery, or before it is born (Bhide & Thilaganathan, 2019).

Maternal prognosis is only okay if there is a way to control bleeding. The fetal prognosis, on the other hand, depends on the blood lost and gestational age. On the other hand, anemia can be controlled through a blood transfusion to allow the full development of the pregnancy. In rare cases, a woman can experience placenta previa at the end of the first trimester. The problem is generally experienced in the last two trimesters (Bhide & Thilaganathan, 2019).

A woman with placenta previa can experience bleeding throughout the pregnancy and also during delivery. If the problem does not resolve, then a C-section is done to deliver the baby. This nursing care plan aims to manage and treat placenta previa through assessing, diagnosing, planning, implementing, and evaluating. Through the nursing plan, we aim at ensuring that the baby is delivered safely and is viable. One of the therapies that shall be included in the treatment is the IV line through the application of a large-bore catheter.

Assessment

The 32-year-old patient, who is at the 32 weeks of her pregnancy, complained of progressive blood loss on arrival to the hospital. On assessment, the patient manifested bleeding episodes for the last five days. She insisted that she had not been involved in any form of an accident before the bleeding started. She also said that she had no pain and that she still felt the movement of the fetus. During the general examination, we noted that though the bleeding was not extreme, we needed to change her pad at least every five hours.

Her blood pressure was low, and her abdomen was soft when palpated. She also had a decreased respiratory rate at 11 breaths per minute, with the fetal heart rate lower than the standard rate of 90 breaths per minute. Her blood pressure is at 118/73, her temperature is at 98.6 F, and her oxygen saturation at 97%. Her skin was clammy, cold, and pale, while she also complained of increased urine output. Her hemoglobin level was at 11.6.

Patient does not have a past medical history of any disease.

Diagnosis

Generally, placenta previa is diagnosed by performing an ultrasound on the patient (Carusi, 2018). While the patient had earlier gone through a routine ultrasound, we shall conduct another one to check why she is experiencing the current vaginal bleeding during her last appointment. Since she is in her second trimester, the ultrasound will be easy and more viable to perform. The diagnosis of placenta previa combines transvaginal ultrasound and abdominal ultrasound, which is conducted through a wand-like device placed inside the patient's vagina (Carusi, 2018).

The positioning of the transducer will be done carefully to avoid causing more bleeding or disrupting the uterus. Possibly, if the bleeding is heavy, which is a high indication that the patient has placenta previa, then we shall avoid the normal vaginal exams to reduce heavy bleeding risks. If necessary, we shall perform more ultrasounds to determine the exact positioning of the placenta and determine if the placenta previa issue is resolved. This nursing diagnosis is related to Florence Nightingale’s concepts and theory because they provide a road map of promoting healing and routine clinical practice. Importantly act as a custodian of ethics and care environment, which gives quantities and considerate process that attains an optimum healthcare delivery.

Planning

One of the goals in this care plan is to ensure that the mother and the fetus are safe. To do this, we will record all the vital signs of the mother, assess the level of bleeding, and maintain a count on the perineal pad. We shall also weigh the pad before and after use to determine the level of bleeding. We shall observe if the patient is in shock by checking her pulse, moist skin, pallor, or low blood pressure. To reduce the risk of losing the pregnancy, the patient will be admitted and restricted from movements.

Blood loss will continue to be monitored to determine if it is increasing or decreasing. The patient, along with her family, will be educated about her condition and the management plan. The mother will be advised to rest in a side-lying position to improve blood flow to the fetus and vital organs. A sonogram might be ordered to localize the placenta. In cases where bleeding persists or worsens, and to prevent preterm delivery complications, a cesarean section could be scheduled from the 36th week of gestation.

If her bleeding stops for more than 48 hours post-admission, she may be discharged with instructions for bed rest, with immediate return advised if bleeding recurs. She will also be counseled on maintaining good hygiene to prevent infection during the remaining pregnancy. It's essential to address her psychosocial and emotional needs, providing emotional support to mitigate anxiety or depression during pregnancy and postpartum.

Interventions

Key interventions include monitoring vaginal bleeding by weighing pads to estimate blood loss and differentiate between old and active bleeding. Placing the mother in a left-side lateral position is critical as it enhances placental blood flow, reduces pressure on the inferior vena cava, and improves cardiac output (MacGibbon & Ius, 2018). Elevating her pelvis when awake can offer similar benefits.

Monitoring for signs of dehydration and hypovolemia is essential, as significant blood loss can lead to hypovolemic shock. Administering IV fluids will help maintain circulatory volume and hemodynamic stability. To promote fetal lung maturity, she will receive antenatal corticosteroids if gestation is between 24 and 34 weeks, but in this case, given her 32 weeks, corticosteroids can be administered to accelerate lung development (Roberts & Dalziel, 2019).

Blood transfusions will be prepared if her hemoglobin levels drop significantly, aiming to correct anemia and improve oxygen delivery (Tucker et al., 2018). Iron supplementation support, both parenteral and oral, will be provided to replenish iron stores. To minimize constipation and avoid further bleeding caused by straining, stool softeners and high-fiber diet suggestions are part of the care plan (Ahmed et al., 2022).

Given the risk of Rh incompatibility, anti-D immunoglobulin will be administered to Rh-negative women to prevent alloimmunization if fetomaternal hemorrhage occurs (Smith & Johnson, 2020). The entire episode of bleeding will be closely monitored, with repeating doses if bleeding persists beyond three weeks after initial administration.

Delivery planning emphasizes that cesarean section is most likely the safest option due to the placenta's position over the cervix and ongoing bleeding. The decision involves continuous maternal and fetal monitoring, including laboratory assessments (complete blood count, crossmatch, fibrinogen levels, and coagulation profile) to guide transfusion needs and assess clotting function. Fetal heart rate monitoring will be continuous to detect distress.

If discharged before delivery, the mother will be advised to adhere strictly to bed rest and to return immediately if bleeding resumes or worsens. Education on signs and symptoms of complications, hygiene practices, and the importance of prenatal care adherence will be emphasized (Heffner et al., 2020).

Evaluation

The patient’s ongoing evaluation focuses on her response to treatment, stability of bleeding, and fetal well-being. Regular assessment of vital signs, blood loss, laboratory parameters, and fetal heart rate will inform clinical decisions. Improvement in hemodynamic status, stabilization of hemoglobin levels, and absence of further bleeding episodes will be positive indicators.

Her readiness for delivery will be reassessed continuously, and delivery will be scheduled based on fetal maturity, maternal condition, and bleeding status. In this case, given her gestational age and ongoing bleeding, cesarean delivery remains the most appropriate and safest mode of delivery to minimize maternal and fetal risks (Gül et al., 2021). Postpartum care will include monitoring for hemorrhage, providing emotional support, and educating the mother on postpartum warning signs and follow-up care.

References

• Ahmed, S., Ghulam, M., & Malik, S. (2022). Management of postpartum constipation: An overview. Journal of Obstetrics and Gynecology, 42(4), 512–518.
• Gül, N., Usta, D., & Yıldız, S. (2021). Cesarean section indications and outcomes: A comprehensive review. Turkish Journal of Obstetrics and Gynecology, 18(2), 102–110.
• Heffner, L. J., et al. (2020). Obstetric emergencies: Management strategies. Maternal-Fetal Medicine Journal, 33(6), 575–582.
• MacGibbon, A., & Ius, M. (2018). Conservative Management of Abnormally Invasive Placenta Previa after Midtrimester Fetal Demise. Case Reports in Obstetrics and Gynecology, 2018, 1–5.
• Roberts, D., & Dalziel, S. (2019). Antenatal corticosteroids for accelerating fetal lung maturation. Cochrane Database of Systematic Reviews, (3).
• Smith, J., & Johnson, L. (2020). Rh immunoglobulin use in obstetric practice. Journal of Reproductive Immunology, 138, 103150.
• Tucker, M. A., et al. (2018). Transfusion strategies in obstetric hemorrhage. Blood Reviews, 32(4), 240–248.
• Bhide, A., & Thilaganathan, B. (2019). Recent advances in the management of placenta previa. Current Opinion in Obstetrics and Gynecology, 31(6), 447–451.
• Carusi, D. (2018). The Placenta Accreta Spectrum: Epidemiology and Risk Factors. Clinical Obstetrics & Gynecology, 61(4), 802–810.
• Allahdin, S., Voigt, S., & Htwe, T. (2017). Management of placenta previa and accrete. Journal of Obstetrics and Gynecology, 31(1), 1–6.