I.

INTRODUCTION
Placenta previa is an obstetric complication that classically presents as painless

vaginal bleeding in the third trimester secondary to an abnormal placentation near or

covering the internal cervical os. Placenta previa occurs in four degrees: implantation in
the lower uterine rather than in the upper portion of the uterus (low-lying placenta);
marginal implantation (the placenta approaches that of cervical os); implantation that
protrudes a portion of the cervical os (partial placenta previa and implantation that
totally obstructs the cervical os (total placenta previa). The degree to which the placenta
covers the internal cervical os is generally estimated in percentages 100%, 75%, 30%
and so forth. Increased parity, advanced maternal age, past cesarean births, post
uterine curettage, multiple gestations, and perhaps a male fetus are all associated with
placenta previa.
The incidence of placenta previa is approximately 5 per 1,000 pregnancies. It is
thought to occur whenever the placenta is forced to spread to find an adequate
exchange surface. An increase in congenital fetal anomalies may occur if the low
implantation does not allow optimal fetal nutrition or oxygenation. The incidence of
placenta previa in the United States is approximately 0.5%, or 1 in 200 women. The
maternal mortality rate is 0.03%. The retrospective "Maternal Mortality Study" (19791986) showed that in 44 maternal deaths, placenta previa was listed as an underlying
obstetric condition contributing to death. This resulted in a case fatality rate of .03%.
The incidence of maternal death was 1 in 3,300 cases of placenta previa. There are still
no current trends about the medications and other diagnostic procedures in preventing
and curing placenta previa. Ultrasonography is still the basis of diagnosis but for patient
with cases of abdominal wall scarring, obesity, or an incomplete filled bladder, MR
imaging reveals placenta previa since in ultrasonography placenta previa may not be
clearly seen due to blockage of cord-placenta insertions or vessels over the cervix
during visualization.

The reporter chooses this case because more clinical skills will be developed by
exploring the clinical management of this disease-condition and it will enhance ones
knowledge in implementing proper nursing intervention to the patient towards recovery.
One of the most perceived importances to conduct this study is to enable the
student nurses to practice the concepts and knowledge learned from the four-sided
room to the actual clinical setting. By this, the students knowledge, skills and
experience will be enhanced. This case study also provides ways to practice the nursing
process which is the core of nursing profession.
In relation with this case study is systematic in nature. It gives acquaintance to
the condition known as Placenta Previa. It allows the student to acquire specific
information on the said condition and able to obtain knowledge on what are the proper
medical interventions that should be done and the rationale for such procedure.
In a deeper sense, the case study wanted to be part of the development of selfcare to prevent the said condition and to achieve the optimal health of our patients in
the future.
II.

OBJECTIVES

Nurse Centered:
General:
To enhance the students skills, comprehension and approach in the practice of
nursing and be able to establish knowledge on the risk factors, prognosis nursing
management, current trends and incidence of the disease condition that was chosen.
Specific:

To come up with a comprehensive presentation of the disease condition by

means of correct presentation of the data gathered through the use of nursing
process.

To present the current trends about the disease condition; the reason for
choosing such case for presentation; and the importance of the case study.

Understand the factors that might have contributed to the development of the
disease

Provide organized and structured nursing interventions as a response to the

patients anticipated needs

Provide

relevant

information

on

available

alternative

therapies

and

management
To impart knowledge about the importance of healthy lifestyle.
To render proper nursing management and medical regimen needed by the
patient with placenta previa.
To identify predisposing factors that aggregate the present condition.

III.

INITIAL DATA BASE

IV.

DEFINITION OF DIAGNOSIS

Placenta previa is an obstetric complication in which the placenta is lying unusually low
in the uterus, next to or covering the cervix. The placenta is the pancake- shaped
organ normally located near the top of the uterus that supplies the baby with
nutrients through the umbilical cord.
Placenta previa is a placental attachment that is too low in the uterus and covers the
cervix. Normally the placenta is attached to the uterus above the cervix. The placenta
completely covers the internal os in slightly more than 10 percent of placenta previa
cases. Under these circumstances the placenta precedes the fetus in vaginal delivery.
This can be life-threatening to the unborn child and mother if untreated. It occurs to
some degree in 1 of 200 pregnancies.

Placenta previa is not usually a problem early in pregnancy. But if it persists into later
pregnancy, it can cause bleeding, which may require the pregnant woman to deliver
early and can lead to other complications. If a woman has placenta previa when it's
time

to

deliver

her

baby,

shell

need

to

have

c-section.

If the placenta covers the cervix completely, it's called a complete or total previa. If it's
right on the border of the cervix, it's called a marginal previa. (You may also hear the
term "partial previa," which refers to a placenta that covers part of the cervical opening
once the cervix starts to dilate.) If the edge of the placenta is within 2 centimeters of the
cervix but not bordering it, it's called a low-lying placenta. The location of the placenta
will be checked during the midpregnancy ultrasound exam.

It depends on how far along the client is in pregnancy. Don't panic if her second
trimester ultrasound shows that she has placenta previa. As her pregnancy progresses,
the placenta is likely to "migrate" farther from the cervix and no longer be a problem.
(Since the placenta is implanted in the uterus, it doesn't actually move, but it can end up
farther from the cervix as theuterus expands. Also, as the placenta itself grows, it's
likely to grow toward the richer blood supply in the upper part of the uterus.)
Only about 10 percent of women who have placenta previa noted on ultrasound at
midpregnancy still have it when they deliver their baby. A placenta that completely
covers the cervix is more likely to stay that way than one that's bordering it (marginal) or
nearby(low-lying).
Even if previa is discovered later in pregnancy, the placenta may still move away from
the cervix (although the later it's found, the less likely this is to happen). You'll have a
follow-up ultrasound early in your third trimester to check on the location of your
placenta. If the client has any vaginal bleeding in the meantime, an ultrasound will be
done then to find out what's going on.

If the follow- up ultrasound reveals that the placenta is still covering or too close to the
cervix, the client will be monitored carefully, has regular ultrasounds, and need to watch
for vaginal bleeding. She'll be put on "pelvic rest," which means no intercourse or
vaginal exams for the rest of her pregnancy. And she'll be advised to take it easy and
avoid activities that might provoke bleeding, such as strenuous housework or heavy
lifting.
Bleeding from a placenta previa happens when the cervix begins to thin out or dilate
(even a little) and disrupts the blood vessels in that area. It's usually painless, can start
without warning, and can range from spotting to extremely heavy bleeding. If her
bleeding is severe, she may have to deliver her baby
premature.

The

pregnant

woman

may

also

right away, even if he's still

need

blood

transfusion.

It's unusual for bleeding to start before late in the second trimester, and about half the
time it doesn't begin until you're nearly full-term (37 weeks). The bleeding will often stop
on its own, but it's likely to start again at some point. (If she has bleeding and shes Rh
negative, she'll need a shot of Rh immune globulin, unless the baby's father is Rh
negative,too.)
If the client start bleeding or has

contractions, she'll need to be hospitalized. What

happens then will depend on how far along you are in her pregnancy, how heavy the
bleeding is, and how you and your baby are doing. If she is near full-term, the baby will
be delivered by c-section right away. If the baby is still premature, he'll be delivered by
c-section immediately if his condition warrants it or if the client have heavy bleeding that
doesn't stop.

Otherwise, she'll be watched in the hospital until the bleeding stops. If shes less than
34 weeks,

the client may be given corticosteriods to

speed up her baby's lung

development and to prevent other complications in case he ends up being delivered

prematurely.

If the bleeding stops, and both the mother and her baby are in good condition, she'll
probably be sent home. But she'll need to return to the hospital immediately if the
bleeding starts again. If she and her baby continue to do well and she doesn't need to
deliver

early,

she'll

have

scheduled

c-section

at

37

weeks.

No matter when she delivers, if she still has placenta previa, she'll need a c-section.
With a complete previa, the placenta blocks the baby's way out. And even if it's only
bordering the cervix, she'll still need a c-section in most cases because the placenta
could bleed profusely if the cervix dilated.

V.
VI.
VII.
VIII.

PATHOPHYSIOLOGY
A. NARATIVE
B. DIAGRAM
MEDICAL MANAGEMENT
RELATED NURSING THEORY
NURSING MANAGEMENT
A. NCP
B. DISCARGE PLAN
C. PROGNOSIS