Placenta Previa: Causes, Symptoms, Treatment, and Care

Placenta Previa: Causes, Symptoms, Treatment, and Care

Placenta previa is a condition where the placenta does not attach to the fundus of the uterus, but rather attaches partially or completely to the lower segment of the uterus and cervix.

Classification:

• Central placenta previa:

• Partial central placenta previa: The placenta covers a part of the cervical os.

• Complete central placenta previa: The placenta completely covers the cervix.

• Non-central placenta previa:

• Low-lying placenta: The edge of the placenta is attached to the lower segment of the uterus, but not yet reaching the cervical os.

• Marginal placenta previa: The edge of the placenta reaches the edge of the cervical os.

Symptoms:

• Functional:

• Sudden vaginal bleeding, without abdominal pain, bright red blood, varying amounts.

• No symptoms, placenta previa can only be detected by ultrasound.

• Soft uterus, not tense or painful.

• Physical:

• Palpation of the abdomen reveals a high or abnormal presentation (due to the placenta attaching to the lower segment of the uterus, the fetal presentation is not well-adjusted).

• Fetal heart rate is still audible, except in cases of severe blood loss affecting uteroplacental circulation (fetal shock from blood loss, placental abruption).

• Speculum examination: Bright red blood mixed with blood clots from the cervical os.

• Vaginal examination is not recommended, it should only be performed in the operating room when there is heavy vaginal bleeding or when it is necessary to terminate the pregnancy.

• If labor has already started, the uterine muscle tone is still soft and normal between contractions.

• Systemic:

• Vital signs correspond to the amount of blood loss.

• Usually the general condition is still good, except in cases of excessive blood loss.

Diagnostic procedures:

• Ultrasound: Currently the most effective and accurate method to determine the location of the placenta.

• MRI:

Management and prognosis:

• Depends on:

• The severity of vaginal bleeding.

• Gestational age.

• Whether labor has started.

1. If labor has not started:

• Fetus is too premature:

• Minor vaginal bleeding: Hospitalize the patient for monitoring, no vaginal examination. If necessary, transfuse blood to the patient, and Papaverine can be used to reduce contractions.

• If bleeding continues and becomes serious: Emergency Cesarean section.

• Full-term pregnancy: Depending on the individual case, labor can be induced or a Cesarean section can be performed without waiting for labor to start.

2. If labor has started:

• Central placenta previa: Immediate Cesarean section combined with resuscitation.

• Non-central placenta previa: Most cases can be delivered vaginally if there are no other factors contributing to difficult labor.

Prognosis:

• Maternal: The prognosis is quite good.

• Fetal: The mortality and morbidity rate is still high due to prematurity, fetal distress due to maternal blood loss, and bleeding from placenta previa.

Care for pregnant women with placenta previa:

1. Before labor:

• Inform the family and the pregnant woman about the nature of the bleeding.

• Monitor uterine contractions, bleeding, and its consequences.

• Plan a diet rich in protein, nutrients, and anti-constipation, and supplement with essential micronutrients.

• Prepare blood reserves.

• Bed rest, limit movement.

• Adhere to the prescribed treatment and laboratory examinations correctly, promptly, and completely.

• Prepare for emergency bleeding management: Close monitoring, early detection.

• Maintain external genital hygiene.

• Monitor fetal development.

2. During labor:

• Mobilize personnel to be present to monitor and care for the patient and request family members to cooperate with the hospital.

• Monitor the progress of labor and fetal status.

• Implement prescribed care, treatment, and urgent laboratory examinations.

3. After delivery:

• Care plan:

• Baby: Appropriate care plan according to gestational age, weight, and medical conditions. If the baby dies, strictly implement the death protocol.

• Mother: Breastfeeding or keeping and promoting lactation. Nutritional diet for the mother. Care for the incision, episiotomy sutures, and prevention of postpartum infection.

• Implementation of the care plan:

• Baby: Care for the baby in suitable conditions: prevent hypothermia, ensure airway patency, ensure nutritional intake with breast milk, maintain hygiene to prevent infection, monitor respiratory, cardiovascular, digestive, urinary, and body temperature functions.

• Mother: Monitor bleeding for the first 12 hours after delivery, then monitor the risk of infection based on vital signs. Postpartum care is the same as other postpartum cases.

Main clinical symptoms of placenta previa: Painless vaginal bleeding.

Multiple Choice Questions:

1. Placenta previa is defined as the placenta not attaching to the …………….. but rather partially or completely attaching to the lower segment of the uterus.

>> fundus of the uterus

2. Low-lying placenta is when a portion of the placenta is attached to the lower segment, but the edge of the placenta has not reached the cervical os.

>> A. True

3. Which of the following statements is INCORRECT when implementing the nursing plan for a pregnant woman in labor with placenta previa?

>> A. It is not recommended to inform the family about the vaginal bleeding during the patient’s labor.

4. The typical symptom of placenta previa is:

>> C. Sudden bleeding, self-stopping with the risk of recurrence

5. The care plan for pregnant women with placenta previa before labor includes:

>> C. All of the above are true

I hope this is a good translation! Let me know if you have any other questions.