Placenta Previa for Certified Emergency Nursing (CEN)
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Outline
Placenta Previa
Definition/Etiology:
Implantation of the placenta in the lower uterine segment or over the internal os.
Pathophysiology:
As the fetus grows, there is more pressure on the placenta. A placenta in this position has the potential to bleed through the cervix causing potential hemorrhage and risk to the fetus. Underlying etiology is unknown.
Risk factors include:
- Advanced maternal age
- multifetal gestation
- smoking
- previous c-section
- hx of previous placenta previa
Clinical Presentation:
- Sudden PAINLESS BRIGHT red bleeding in the second or third trimester
- Uterus will be soft and non-tender (uterus is not the problem, placenta is)
- May have increased fundal height due to the placenta pushing baby up
- Signs of maternal shock may be present
Collaborative Management:
Large bore IVs for fluid resuscitation
Get labs:
- CBC
- BMP
- Type and Cross
- ABO
Evaluation | Patient Monitoring | Education:
- Hemodynamic monitoring – watch for shock!
- Fetal monitoring
- VAGINAL EXAM = BIG NO NO
- Placenta is sitting on the top of the cervix so if you open the cervix, you could further disrupt the placenta
- Usually results in a c-section
Linchpins: (Key Points)
- Painless, bright red bleeding
- Bedrest, no intercourse and no digital exams!
- Gynecological emergency!!
- Usually results in a c-section
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Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Anderson-Bagga, F. M., & Sze, A. (2019). Placenta previa.
- Sheehy, S. B., Hammond, B. B., & Zimmermann, P. G. (2013). Sheehy’s manual of emergency care. 7th ed. / St. Louis, Mo., Elsevier/Mosby.
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