The topic I have chosen for my journal is placenta previa. My patient, 39-year-old M.C came in to the hospital for her fourth cesarean delivery. She has three healthy children that are twenty, ten and two years old. She is not a good candidate for vaginal birth because she has an android or heart shaped pelvis. The birth of her first child resulted in an emergency cesarean delivery and she has opted to have planned cesarean deliveries since then. During this pregnancy M.C had preeclampsia, which is an increase in blood pressure after 20 weeks gestation, which is also commonly accompanied by protenuria. During this pregnancy M.C also had placenta previa, which is a placental implantation in the lower uterine segment over or near the internal os of the cervix (Buckley & Schub, 2013). M.C did not have this complication in her other 3 pregnancies. It is a very rare occasion occurring in only 2 per 1,000 births or 0.3-0.5% of all pregnancies in the United States.
Placenta previa occurs during the second or third trimester. There are three types of placenta previa, which are total, partial and marginal. M.C presented with marginal placenta previa also known as low lying, which occurs when the edge of the placenta reaches the internal cervical os (Buckley & Schub, 2013).
The cause of placenta previa is not known but it may be from abnormal vascularization due to a prior uterine injury (Buckley & Schub, 2013). M.C presented with vaginal bleeding during her pregnancy and that is when she found out about her condition. Placenta previa is the most common cause
of bleeding in the second half of pregnancy (Buckley & Schub, 2013). If a patient presents with sudden, painless vaginal bleeding beyond 20 weeks gestation than placenta previa should be suspected. If placenta previa is suspected the use of a transvaginal ultrasound is the most useful diagnostic tool and has an accuracy of 100% in diagnosing placenta previa.
After M.C was diagnosed with placenta previa she was ordered to be on bed rest for the rest of her pregnancy and was monitored very closely by her obstetrician. There are many potential complications that come with placenta previa and a few are premature rupture of membranes, preterm birth, placental abruption, postpartum hemorrhage, anemia, infection disseminated intravascular coagulation, shock, renal failure, thrombophlebitis and maternal or fetal death (Buckley & Schub, 2013). According to Buckley & Schub, (2013) “ for women who have had multiple cesarean deliveries the risk for placenta previa can reach 10%” and M.C had three previous cesarean sections which could be a reason why she developed this condition. M.C was carrying a boy and placenta previa is also more common in pregnancies with male fetuses (Buckley & Schub, 2013). Fortunately M.C was able to carry her baby boy to term but 50% of women with placenta previa have a preterm delivery.
The treatment goals for patients with placenta previa is to monitor the mothers vital signs, vaginal bleeding and watch for physiologically signs of hemorrhage, shock and infection. Closely monitor the fetal heart tones for any type of distress such as bradycardia, tachycardia and late and variable decelerations. Closely monitor post-surgical patients for bleeding, infection and other complications. Assess the patient’s anxiety level and any knowledge deficits the patient might have regarding placenta previa. Provide the patient is emotional support, education regarding the condition and reassurance that the prognosis is usually good.
Courtney from Study Moose
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