Abruptio placentae and placenta previa are two of the most common maternity complications involving the placenta. To be able to take proper care of patients experiencing these conditions, a nursing student must fully understand their pathophysiologies. Let’s go over their definitions, risk factors, signs and symptoms, and appropriate nursing care.
Before we proceed further, let’s recap on the crucial role of the placenta during pregnancy. This organ that develops during pregnancy is attached to the uterine wall, and the umbilical cord connects it to the fetus. The placenta is responsible for providing nutrients and oxygen to the fetus; at the same time, it is crucial for removing waste products from the baby’s blood.
Any complication involving the placenta is life-threatening to both the mother and the fetus. That is why nurses need advanced knowledge to properly monitor these patients.
In normal cases, the placenta is attached at the top or the sides of the uterus. But, if the placenta’s attachment partially or totally covers the cervical opening, then this should be a problem. We call this condition “placenta previa.”
Types of Placenta Previa
If the placenta is abnormally placed, it can cover the cervical opening partially, marginally, or totally. That’s why it’s classified into three types of Placenta Previa:
- Total or Complete Placenta Previa: This occurs when the placenta covers the ENTIRE cervical opening.
- Partial Placenta Previa: This happens when the placenta covers the cervical opening PARTIALLY. Others may call this as a low-lying placenta.
- Marginal Placenta Previa: This happens when the placenta is at the edge or the margin of the cervical opening. Just like partial placenta previa, it is also known as a low-lying placenta.
Diagnosis of Placenta Previa
Placenta previa can be diagnosed through ultrasound in as early as the 20th week of pregnancy. In some cases, the placement of the placenta corrects on its own throughout the pregnancy.
As the uterus grows, the placenta may move upward and away from the cervix. That’s why healthcare providers recommend a follow-up ultrasound on the 32nd week of pregnancy.
Risk Factors of Placenta Previa
- Multiple pregnancies
- Maternity age above 35 years old
- Alcohol or drug use
- Scarred uterus because of previous surgery (e.g., D&C, CS Delivery)
Signs and Symptoms of Placenta Previa: PREVIA
To easily remember the signs and symptoms of placenta previa, remember the acronym PREVIA.
- Painless vaginal bleeding: the bleeding may be mild to profuse, and the blood color is usually BRIGHT RED
- Relaxed Uterus: Soft and non-tender uterus
- Episodes of Bleeding: This is not classified as spotting, because the cervix goes through the thinning stage, where there is the tearing of the blood vessels in the placenta., this then causes the bleeding.
- Visible Bleeding: Unlike in the case of abruptio placentae where the bleeding occurs inside, with placenta previa, it is visible bright red bleeding.
- Intercourse post-bleeding: There are episodes of spontaneous bleeding or during labor.
- Abnormal Fetal Position: The fetus may be in a breech (buttocks first on the cervical opening) or transverse position (sideways).
Nursing Care for Placenta Previa
The management for placenta previa depends on the severity of bleeding, gestational age, fetus’ condition, fetal position, and type of placenta previa. As for general care, here are the expected interventions.
- Advise patient to avoid: sexual intercourse, strenuous exercise, and douching.
- Monitor: Mother’s vital signs (every 15 minutes), bleeding, and fetal heart rate.
- For Blood loss: Monitor for signs of hemorrhage and expect the possibility of blood transfusion.
- Position: Place the mother on a left side-lying position to increase the amount of blood entering the placenta
- Expect for: tocolytic drugs to be prescribed, Amniocentesis to assess the fetus lung maturity, C-section for total or partial placenta previa
- Complication: Monitor for signs of Placenta Accreta (a life-threatening condition during pregnancy where the placenta is too attached to the uterine wall, this may cause severe blood loss after the delivery)
Now let’s tackle abruptio placentae or, as others would call it, “placental abruption.” It is a condition wherein the placenta prematurely detaches from the uterus even before childbirth.
In normal circumstances, the placenta should detach from the uterine wall 10-20 minutes after childbirth. If the placenta separates from the uterine wall before giving birth, this is bad news. Abruptio placentae are classified into two types, depending on the severity of the detachment: Partial or Total Detachment.
Risk Factors of Abruptio Placentae: ABRUPTION
- Abruptio placentae in previous pregnancies
- Blood Pressure related problems: Hypertension, Preeclampsia, Eclampsia or HELLP Syndrome (hemolysis, elevated liver enzyme levels, and low platelet levels)
- Rupture of Membranes: Early rupture of membranes that leads to the premature of leaking of amniotic fluids
- Uterine Scarring or Tear dues to multiple pregnancies or surgery involving the uterus
- PROM: Premature Rupture of the Membranes
- Trauma to the abdomen (e.g., fall or blow)
- Infection in the uterus (e.g., Chorioamnionitis)
- Older maternal age, especially 40 years old and above
- Narcotics or nicotine use (e.g., tobacco smoking, cocaine)
Signs and Symptoms of Abruptio Placentae: DETACHED
- Dark red vaginal bleeding
- Extended fundal height due to the increasing uterine hematoma
- Tenderness or rigidity of the uterus
- Abdominal pain and contractions: Even back pain may be experienced suddenly
- Concealed bleeding: The bleeding occurs inside the uterus and may lead to shock without seeing the extent of blood loss.
- Hard, rigid, board-like abdomen
- Enters into DIC (Disseminated Intravascular Coagulation): May lead to severe blood loss and is life-threatening
- Distressed fetal heart rate
Nursing Care of Abruptio Placentae
- Monitor: Signs of bleeding, vital signs every 15 minutes, signs and symptoms of DIC, presence of gum bleeding, ecchymosis, petechiae, micro-emboli, urinary output, the difficulty of breathing, chest pain, fundal height, abdominal girth, laboratory values (platelets and prothrombin levels), IV sites for bleeding, fetal heart rate and tone
- Avoid: Supine position, vaginal exams, abdominal manipulation
- Position: Left-side lying
- Expect: Blood transfusion, administering of IV fluids, CS delivery if the mother and fetus show signs of distress.
It’s worth noting that placenta previa is an “attachment issue,” while abruptio placentae is a “detachment issue.” Nurses must realize that these are delicate pregnancy conditions needing utmost care and attention. For both pregnancy complications, it is crucial to monitor for possible blood loss on the mother and the baby’s heart rate.