Portfolio II: Objective 5 Pathophysiology Placenta previa is a high risk obstetrical condition in which the placenta implants over the cervical os. It occurs in 1 of 200 pregnancies, and is associated with risk to the fetus or mother through hemorrhage, abruption or separation of the placenta, and emergency cesarean section. This bleeding condition occurs in the last two trimesters of pregnancy and the cause is relatively unknown. It occurs when the embryo implants in the lower uterus, and the placenta grows over the cervical os, causing bleeding and risk to the fetus and mother. In addition, placental vascularization is defective and may attach directly, invade, or penetrate the myometrium (Ricci & Kyle, 2009). Types Total placenta previa refers to the condition when the cervical os is completely covering the cervical os. Partial placenta previa means partial coverage, marginal placenta previa means the placenta is at the edge of the os, and low-lying is when the placenta is implanted in the lower uterine segment and near the os but not reaching it (Ricci & Kyle, 2009). Symptoms and Management The primary symptom of placenta previa is painless, bright red vaginal bleeding in the second or third trimester. Diagnostic measure include transvaginal ultrasound, to view the position of the placenta, and MRI to identify other rare placental abnormalities which carry high risk of morbidity and mortality (Ricci & Kyle, 2009). The treatment for this condition depends on the severity and factors such as: amount of bleeding, stability of mother and baby, and the extent to which the placenta is covering the cervical os. In milder cases where the fetus and mother are both stable and there is not active bleeding, the mother can be placed on bed rest at home (Ricci & Kyle, 2009). In most cases, cesarean delivery is necessary. In severe or complicated cases, and if bleeding is not stopped after delivery, hysterectomy is sometimes performed (Ricci & Kyle, 2009). There is research on alternatives to hysterectomy, as many young women obviously do not want this option. Among the promising options with evidence of saving the mother’s life and stopping postpartum bleeding is balloon tamponade in the uterus. Intrauterine balloon tamponade was proven to be effective at controlling hemorrhage and preventing complications on all patients it was used on for extensive bleeding unresponsive to medical treatment, is cost efficient, easy to use, and saves the women from possible hysterectomy (Ishi, Sawada, Koyama, Isobe, Wakabayashi, Takiuchi, Kanagawa, Tomimatsu, Ogita, & Kimura, 2012). Nursing Goals Nursing management of placenta previa focuses on keeping the mother and fetus safe, assessing for symptoms of bleeding, and monitoring for fetal distress. Specific goals include (1) maintain adequate tissue perfusion and (2) minimize anxiety (Ricci & Kyle, 2009). (1) Maintain Adequate Tissue Perfusion Interventions (Ricci & Kyle, 2009):
Interventions (Ricci & Kyle, 2009):
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