📌 NCLEX Topic: Placenta Previa

📌 NCLEX Topic: Placenta Previa

NCLEX Topic: Placenta Previa

Description:

Placenta previa is a condition in which the placenta implants abnormally in the lower uterine segment, partially or completely covering the cervix. It is a major cause of painless vaginal bleeding in the second half of pregnancy.

NCLEX Test-Taking Strategy:

  • Painless, bright red vaginal bleeding (Think placenta previa!)
  • No contractions, no abdominal pain (NOT abruptio placentae!)
  • DO NOT perform a vaginal exam!

Summary for NCLEX:

  • 🩸 Placenta previa causes painless, bright red vaginal bleeding in the second half of pregnancy.
  • 🚨 Vaginal exams are NEVER performed in placenta previa.
  • ⚠️ Complete placenta previa always requires a cesarean delivery.

Types of Placenta Previa:

  • Total (Complete): The placenta completely covers the cervix when fully dilated.
  • Partial: The placenta partially covers the cervix but does not completely obstruct it.
  • Marginal (Low-lying): The placenta is implanted near the cervix, but more than 3 cm away from the internal cervical os.

⚠️ Management of placenta previa depends on its classification and the gestational age of the fetus.

Assessment Findings (Signs & Symptoms):

  • ✅ Sudden onset of painless, bright red vaginal bleeding in the second or third trimester.
  • ✅ Soft, relaxed, and nontender uterus.
  • ✅ Fundal height may be larger than expected due to abnormal placental positioning.
  • ✅ Normal fetal heart rate pattern, unless there is significant blood loss.

❌ What is NOT a sign of placenta previa?

  • Abdominal pain or contractions (Suggests abruptio placentae instead).
  • Painful vaginal bleeding (More common in abruptio placentae).

Nursing Interventions for Placenta Previa:

🚨 DO NOT Perform Vaginal Exams! – Digital exams are contraindicated because they can cause severe bleeding.

  1. Monitor maternal vital signs & fetal heart rate for signs of distress.
  2. Prepare for an ultrasound to confirm diagnosis.
  3. Maintain bed rest (Side-lying position) to minimize bleeding risk.
  4. Monitor blood loss and signs of hypovolemic shock (tachycardia, hypotension, pallor).
  5. Administer IV fluids, blood products, or tocolytics if prescribed.
  6. Administer Rho(D) immune globulin if the client is Rh-negative.
  7. Prepare for a cesarean section if bleeding is excessive or placenta previa is complete.

⚠️ A complete placenta previa always requires a cesarean delivery.