PLACENTA PREVIA

Question 1

It is an organ that develops in the uterus during pregnancy
- provides oxygen & nutrients to a growing baby.
- removes waste products from the baby’s blood
- serves as the baby’s lungs in utero

Answer 1

Placenta

Question 2

Why does the placenta attach to the fundal area of the uterus?

Answer 2

Increased blood supply

Question 3

A condition wherein the placenta abnormally attaches in the LUS, covering or being near the cervical opening

Answer 3

Placenta Previa

Question 4

Types of Placenta Previa

Answer 4

1) Total / Complete
2) Partial
3) Marginal

Question 5

Placenta attaches completely over the cervical opening

Answer 5

Total / Complete

Question 6

Placenta is partially cover the cervical opening.

Answer 6

Partial

Question 7

Placenta is attached at the edge of the cervical opening

Answer 7

Marginal

Question 8

Causes / Risk Factors of Placenta Previa

Answer 8

• History of placenta previa
• Multiple pregnancies
• Maternal age >35 yrs.old
• Illegal drug use, smoking
• Scarring from previous surgeries like Cesarean sections or removal of fibroids / tumors ; repeated D&Cs

Question 9

Main diagnostic tool to help confirm position of the placenta

Answer 9

Ultrasound

Question 10

A 20-week ultrasound would reveal?

Answer 10

May reveal placenta previa but will eventually resolve as the uterus gorws & expands & the placenta migrates upward

Question 11

When to do a repeat scan or re-evaluation of the location of the placenta

Answer 11

30-32 weeks ultrasound

Question 12

Diagnosis & Management for no placenta previa

Answer 12

• Located >2cm away from the cervical opening
• Labor & NSD is generally safe (C-section for other indications)

Question 13

Diagnosis & Management for Marginal Placenta Previa

Answer 13

• Located at the edge of the cervix
• NSD can be attempted but OR set-up must be available in case of emergency

Question 14

Diagnosis & Management for Partial or Total Placenta Previa

Answer 14

• C-section indicated
• NSD should not be attempted

Question 15

Signs & Symptoms of Placenta Previa

Answer 15

• Painless bright red bleeding
• Relaxed, soft uterus; non-tender
• Episodes of bleeding due to thinning of cervix
• Visible bleeding - blood gushes out of the vagina
• Intercourse-related bleeding
• Abnormal fetal position, FHT normal

Question 16

Nursing Interventions

Answer 16

• Advise pelvic rest
• If no bleeding or light bleeding : bed rest
• If bleeding: hospitalization needed

Question 17

Nursing Interventions during Hospitalization

Answer 17

• Anticipate for initiation of IV access or blood transfusion
• Follow-up Lab Results
• Monitor Fetal & Maternal Well-Being
• Place woman in LLD position
• Anticipate for cesarean section delivery with hysterectomy
• assist in FLM tests
• Administer Medications as ordered

Question 18

A pregnancy complication that occurs when the placenta attaches too deeply to the uterine wall.

Answer 18

Placenta accreta

Question 19

Management of placenta accreta

Answer 19

• Early diagnosis
• Close monitoring of mother and baby
• Planned cesarean delivery
• Possibility of BT due to increased risk of massive bleeding
• In certain cases, hysterectomy is performed

Question 20

Placenta grows into the uterine muscle

Answer 20

Placenta increta

Question 21

Placenta grows through the uterine wall and may grow into other organs.

Answer 21

Placenta percreta

Question 22

Which of the following is the most common kind of placental adherence seen in pregnant women?

A. Accreta
B. Placenta previa
C. Percreta
D. Increta

Answer 22

A. Accreta

Question 23

A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?

A. Placenta previa
B. Abruptio placentae
C. Ectopic pregnancy
D. Spontaneous abortion

Answer 23

B. Abruptio placentae

Question 24

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?

A. Change the client’s position.
B. Prepare for emergency cesarean section.
C. Administer oxygen.
D. Check for placenta previa.

Answer 24

A. Change the client’s position.

Question 25

A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following? A. Activity limited to bed rest B. Platelet infusion C. Immediate cesarean delivery D. Labor induction with oxytocin

Answer 25

A. Activity limited to bed rest

Question 26

A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of: A. Hematoma B. Placenta previa C. Uterine atony D. Placental separation

Answer 26

D. Placental separation

Question 27

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? A. Disseminated intravascular coagulation B. Chronic hypertension C. Infection D. Hemorrhage

Answer 27

D. Hemorrhage

Question 28

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician’s orders and would question which order? A. Prepare the client for an ultrasound B. Obtain equipment for external electronic fetal heart monitoring C. Obtain equipment for a manual pelvic examination D. Prepare to draw a Hgb and Hct blood sample

Answer 28

C. Obtain equipment for a manual pelvic examination

Question 29

Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected? a. Placenta previa b. Abruptio placentae c. Premature labor d. Sexually transmitted disease

Answer 29

a. Placenta previa

Question 30

Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa? a. Amniocentesis b. Digital or speculum examination c. External fetal monitoring d. Ultrasound

Answer 30

d. Ultrasound

Question 31

The common normal site of nidation/implantation in the uterus is: A. Upper uterine portion B. Mid-uterine area C. Lower uterine segment D. Lower cervical segment

Answer 31

A. Upper uterine portion

Question 32

A woman, who is 22 weeks pregnant, has a routine ultrasound performed. The ultrasound shows that the placenta is located at the edge of the cervical opening. As the nurse you know that which statement is FALSE about this finding: A. This is known as marginal placenta previa. B. The placenta may move upward as the pregnancy progresses and needs to be re-evaluated with another ultrasound at about 32 weeks gestation. C. The patient will need to have a c-section and cannot deliver vaginally. D. The woman should report any bleeding immediately to the doctor.

Answer 32

C. The patient will need to have a c-section and cannot deliver vaginally.

Question 33

Your patient who is 34 weeks pregnant is diagnosed with total placenta previa. The patient is A positive. What nursing interventions below will you include in the patient's care? Select all that apply: A. Routine vaginal examinations B. Monitoring vital signs C. Administer RhoGAM per MD order D. Assess internal fetal monitoring E. Placing patient on side-lying position F. Monitoring pad count G. Monitoring CBC and clotting levels

Answer 33

B. F. G.

Question 34

Select all the signs and symptoms associated with placenta previa: A. Painless bright red bleeding B. Concealed bleeding C. Hard, tender uterus D. Normal fetal heart rate E. Abnormal fetal position F. Rigid abdomen

Answer 34

A, D, E.