PATIENTS PROFILE:

Identification data:
Client Name - Rashmi Tiwari
Age / Sex - 20 Y / Female
Name of Spouse/Father - Jagdeep Tiwari
Hospital Registration Number (OPD) - 81762
Ward - A.N.C
Bed No. (IPD) - 8893
Address - Ward No. 3 Rewa
Education - 12th pass
Occupation - House wife
Marital Status - Married
Religion - Hindu
Date of Admission - 02/03/2022
Date of discharge - No
Diagnosis - Primi with 30 week 2 days pregnancy with Placenta Previa
Definition of Diagnosis - The Placenta is implanted partially or completely over the
lower uterine segment its called placenta previa.
Surgery (if any) - No
Date of Surgery - No
CHIEF COMPLAINTS - Patient complain that bleeding from vagina
HISTORY OF PRESENT ILLNESS - Painless Vaginal bleeding
I Trimester - No h/o burning menstruations, Fever, pain abdomen,
and bleeding
II Trimester - Quickening was felt of 5 month of gestation Iron and ca
tablet taken, no h/o pedal edema or headache, no h/o raised
BP and blood sugar. No h/o any drug intake, two doses of
inj. DT vaccine taken.
III Trimester - fetal movement are well, growth scene done at 32 weeks,
showed normal development, weight gain in
pregnancy 12 kg.
NO. Of antenatal visit - 03
Immunization status - done
Obstetric history - Married life 3year
Obstetrical score - G1P0L0A0
Health status of baby - good
MARITAL HISTORY:
Age of marriage - 18 year
Duration of marriage - 2
MENSTRUAL HISTORY:
Menarche - 12 year
Duration - 3-4 day
Interval - 28 day
Flow - Normal
LMP - 13/09/2021
EDD - 20/05/2022
Past medical history - No past medical history
Past surgical history - No surgical history
Family History -
S.N. Name of family Age/ Occupation Relationship Health status Education
member sex to family
member
1. RASHMI TIWARI 20 Y/ F h/w Patient Unhealthy 12th

2. JAGDEEP TIWARI 29Y/ M businessman Husband Healthy Graduate

Family Tree - Nuclear

Personal History:
Dietary habits : - Mixed
Addiction : - No
Drug allergy : - No
Socio-Economic status:
Religion - Hindu
Income - 60000 Rs. (Month)
Education - 12th
Occupation - Businessman
Wife occupation - house wife
Physical examination :
Height : - 158 cm
Weight : - 62kg
Colour of skin : - Pallor
Head :
Shape and size of skull: - Normal
Scalp : - no dandruff
Face : - anxious
Eyes:
Vision : - Normal
Eye brow and eyelid: - Normal
Eye ball: - Normal
Conjunctiva : - pink
Sclera : - Normal
Cornea and iris: - Normal
Pupil : - Normal
Lens : - Normal
Ears :
External ear: - no deformity
Tympanic membrane : - no perforation
Hearing problem - No
Nose :
External nares : - Normal
Nostrils: - Normal
Mouth and pharynx :
Lips : - Pink
Gums - No bleeding
Teeth : - present and clean
Tongue : - good hydrate
Throat and pharynx - dry
Neck:
Thyroid gland - No Enlargement
Lymph node - No Enlarge
Range of motion - present
Chest :
Breath sound: - Increase
Lungs : - Normal
Heart - Increase heart
Breast: - Inlarge
Nipple - An inspection breast symmetrical and muscles get loose
ABDOMEN:
Auscultation : - Bowel sound present
Palpation : - no tenderness
Abdominal girth : - 99 cm at the level of umbilicus
Fundal height: - 36 week, corresponds to gestational age
Lenea Nigra: - present
Percussion – - on percussion there is presence of fluid accumulation
Striae gravidarum - present
Extremities : - movement of joint
Symmetry : - Normal
Edema : - absent
ROM : - Possible
PELVIC EXAMINATION :
Genital and rectum: - Normal
Systematic examination : -
Central nervous system : - no focal neurological deficit
Sensory system : - Normal
Respiratory system : - normal vesicular sounds heards
Cardiovascular system : - S1, S2 Sound heards, no murmurs heards
Gastro intestinal system : Normal
Musculoskeletal system: Normal
Genitourinary system : Normal
Integumentary system : Normal
Vital sign:
S. N. Date and Temperature Pulse Respiration Blood
time pressure
1. 03/03/202 98.60F 72 breath / 18 breath / 120/ 80 mm
2 Min min Hg
 DESEASE DISCRIPTION :
INTRODUCTION:
The placenta is an organ that develops in your uterus during pregnancy. This structure provides
oxygen and nutrients to your growing baby and removes waste products from your baby's blood. The
placenta attaches to the wall of your uterus, and your baby's umbilical cord arises from it.
DEFINITION:
Placenta previa is a condition wherein the placenta of a pregnant woman is implanted abnormally
in the uterus. It accounts for the most incidents of bleeding in the third trimester of pregnancy.
ANATOMY AND PHYSIOLOGY:
The placenta consists of a foetal portion formed by the chorion and a maternal portion formed by
the decidua basalis. The uteroplacental circulatory system begins to develop from approximately day 9
via the formation of vascular spaces called "trophoblastic lacunae".
RISK FACTORS:
Placenta previa is dangerous if not detected early. However, it is also highly preventable once you get to
know the risk factors.
 Advanced maternal age. Women who are over the age of 35 years old are at an increased risk of
developing placenta previa.
 Multiple gestations. The uterus which has accommodated more than one fetus has an increased
risk for placenta previa.
 Increased parity. Women who have given birth to a lot of children have an increased chance of
having placenta previa.
 Past caesarean births. Giving birth via caesarean delivery predisposes the woman to placenta
previa on her next childbearing.
 Past uterine curettage. Scars from a past curettage can affect the implantation of the uterus and
lead to placenta previa.
ETIOLOGY:
Placenta previa (pluh-SEN-tuh PREH-vee-uh) occurs when a baby's placenta partially or totally
covers the mother's cervix - the outlet for the uterus. Placenta previa can cause severe bleeding during
pregnancy and delivery.
CAUSES:
Some of the possible causes and risk factors of placenta previa include:
 Low implantation of the fertilised egg
 Abnormalities of the uterine lining, such as fibroids
 Scarring of the uterine lining (endometrium)
 Abnormalities of the placenta
 Multiple babies, such as twins
 Multiple pregnancies - a woman who has already had six or more deliveries has
a risk of one in 20.
PATHOPHYSIOLOGY:
 The placenta implants on the lower part of the uterus.
 The lower uterine segment separates from the upper segment as the cervix starts to dilate.
 The placenta is unable to stretch and accommodate the shape of the cervix, resulting in bleeding.
SIGNS AND SYMPTOMS:
The following signs and symptoms for placenta previa must be detected immediately by the
health care providers to avoid risking the life of the fetus.
 Bright red bleeding. When the placenta is unable to stretch to accommodate the shape of the
cervix, bleeding will occur suddenly that could frighten the woman.
 Painless. Bleeding in placenta previa is not painless and may also stop as abruptly as it had
begun.
TYPES:
These types of placenta previa are classified according to the degree of the opening that is
covered by the placenta.
 Low lying placenta. The placenta implants in the lower portion instead of the upper portion of
the uterus.
 Marginal implantation. The placenta’s edge is nearing the cervical os.
 Partial placenta previa. A portion of the cervical os is already covered by the placenta.
 Total placenta previa. The placenta occludes the entire cervical os.
DIAGNOSTIC EVALUATION:
IN GENERAL IN MY PATIENT
USG USG
COLOUR DOPLER Blood Group
MAGNATIC RESONANCE
VEGINAL EXAMINATION
Blood group
Investigations:
S.N. Name of Investigation My P.t. value Normal value

1. Blood group A+ve

2. CBC test

3. Hb 8.4 g/dl 12-16 g/dl

4. Packed cell valume 26% 40-54%

5. Total RBC count 3.12 million/cum 4.5-5.5 imlion/cum

6. Mean corpscula valume 84 F1 80-96 F1

7 Mean corpulasem concentration 26 pg 32-36 pg

8 WBC count 5300/cumm 4000-11000

9 Sgot 15 5-40 iu/1

10 SGpt 43 5-45 IU/l

11 /blood sugar 96 L200 mg/dl

12 Thyroid Normal
Medication :
S.No. Drug name Dose Route Action Side effects
1. Inj. Ceftriaxone +SB 1.5 gm IV/BD Antibiotic Nausea

2. Inj. pantaprazol 40 mg IV/OD Proton pump Headache

inhibitors
3. Inj. Iron sucrose 200 mg IV/OD Iron supplement Shivering
4. Inj. metronidazole 100 ml IV/TDS Antifungal skin rashes
5 Inj. Tranexamic acid 500mg IV/TDS Coagulant abdominal pain

6. Inj. Dexona 8mg IM/BD Steroid gastrointestinal

disorder
7. Tab. Iron folic acid 100 mg Oral /OD Iron supplement Diarrhea

8. Tab . MVBC 260mg Oral /OD Vitamin supplement Stomach upset

MANAGEMENT :
MEDICAL MANAGEMENT:
IN GENERAL IN MY PATIENT
Medical interventions are necessary to ensure that the safety of both Bed rest in a foot and
top position.
mother and fetus are still intact.
Iv cannula and infusion
 Intravenous therapy. This would be prescribed by the physician to
of normal saline.
replace the blood that was lost during bleeding.
Blood transfusion
 Avoid vaginal examinations. This may initiate hemorrhage that is

fatal for both the mother and the baby.

 Attach external monitoring equipment. To monitor the uterine
contractions and record fetal heart sounds, an external equipment is
preferred than the internal monitoring equipment.

SURGICAL MANAGEMENT:
IN GENERAL IN MY PATIENT
Surgical interventions are carried out once the condition of both the mother No Surgery
and the fetus has reached a critical stage and their lives are exposed to
undeniable danger.
 Cesarean delivery. Although the best way to deliver a baby is
through normal delivery, if the placenta has obstructed more than
30% of the cervical os it would be hard for the fetus to get past the
placenta through normal delivery. Cesarean birth is then
recommended by the physician.
NURSING MANAGEMENT:
Nurses also play a major role in the care of a woman with placenta previa. They are also entrusted
with the outcome of the lives of both the mother and the child.
NURSING ASSESSMENT:
 Assess baseline vital signs especially the blood pressure. The physician would order monitoring
of the blood pressure every 5-15 minutes.
 Assess fetal heart sounds to monitor the wellbeing of the fetus.
 Monitor uterine contractions to establish the progress of labor of the mother.
 Weigh perineal pads used during bleeding to calculate the amount of blood lost.
 Assist the woman in a side lying position when bleeding occurs.

NURSING DIAGNOSIS:
 Fear related to outcome of pregnancy due to bleeding.
 Assess fetal heart sounds so the mother would be aware of the health of her baby.
 Allow the mother to vent out her feelings to lessen her emotional stress.
 Assess any bleeding or spotting that might occur to give adequate measures.
 Answer the mother’s questions honestly to establish a trusting environment.
 Include the mother in the planning of the care plan for both the mother and the baby.
 Woman is able to discuss her concerns with the health care providers.
 States that hearing the fetal heartbeat assures her of the baby’s safety.
NURSING CARE PLAN -1

Assessment Nursing Goal Planning Interventions Evaluation

Diagnosis
Subjective Fluid To Provides information Asses vital Client
Data valume mainta about maternal and signs before deomnstrtate
Patient deficient in fetal physiologic and after adequate
Complain that realated to fluid compensation to adminisaterin contraction fo
vaginal active and blood loss. g palpate nuerus and
bleeding and blood loss volum Assessment provides uterus naormal
dizziness secondary e of information about veginal amount of
Objective Data to the possible infection, bleeding blood loss
disrupted patient placenta previa or client Bp and
I observe that
placental . abruption. Warm, pulse rate
patient
implantati moist, bloody rate remain
ccessive
on . environment is ideal uisthin
hypothrypy
for growth of normal
trachycrdiya
microorganisms. limits.
 NURSING CARE PLAN -2
Assessment Nursing Goal Planning Intervention Evaluation
Diagnosis
Sub.data. In effective To Extent of pituitary Vital sign are The
Patient complain tissue impr infoldment may be assessed closely effective
that she is perfusion ove related to the degreenail beds or color tissue
suffering from relation to the duration ofof nails or gums perfusion
bleeding. hypo effect hypotension. tongue is is
Obj.Data volemia ive To correct the assessed. improved
evidenced by tissue metabolic acidosis. (ABG) Ph level at some
I observe that
decreased perfu Increases was assessed. extent.
patient is
capillary sion confidence and Sodium
suffering from
rifill or milk hope for a client and bicarbonate was
bleeding as
production . signifiacent other. given the section
avidence by
talking. area removed.
NURSING CARE PLAN -3
Assessment Nursing Goal Planning Intervention Evaluation
Diagnosis
Sub. Data- The altered To To collect base Asseses the Nutrition
Patient complain nutritional maintain line data . nutritional pattern pattern is
that she feel risk pattern less nutritional To present of the patient. maintained
for infraction due then body pattern. dryness of Provide liquid up to some
to excessive requirement skin. fluid and juice to extent.
bleeding related to To maintain the patient.
Obj.data anorexia nutritional Maintain intake
and loss of pattern. and output chart
I obsrve that
blood.
patient she is risk To restore the of the atient.
for infraction fluid.
 Nursing care plan -4
Assessment Nursing Goal Intervention Planning Evaluation
Diagnosis
Sub.Data Risk for To Monitor rate of Infection of the The risk of
Patient complain infection reduced uterine involution uterus delays infection is
that she has not no related to the risk and nature amount involution. reduced at
come about her in decreased of of lochia. These symptoms are some
this condition haemoglo infection. Observed for sign involvement extent .
Obj.data bin inverse of fever chills . possibility bacteria.
procedure Check the These indicator
I observe patient
she is asking more episiotomy site and localised infection.
question about her abdominal wound. Increased in wbc
bleeding . Review wbc , hb, indicated the
and humorist level. infection .
 COMPLICATIONS:
IN GENERAL IN MY PATIENT
Some of the complications of placenta previa include:  Painless Bleeding
Maternal complication :  Blood loss for the Patient
During pregnancy: antepartum haemorrhage,  Fetal distress
malpresention, premature labour
during labour : early rapture of membrane
cordprolaps, intrapartum haemorrhage
puerperium: PPH, retained placenta
Fetal complication :
Low birth weight, asphyxia, intrauterine death

PROGNOSIS:
IN GENERAL IN MY PATIENT
The majority of women with placenta previa in developed My patient is recovering
countries will deliver healthy babies, and the maternal mortality Next checkups in 4th trimester
(death) rate is less than 1%.

HEALTH EDUCATION:
 Position lateral with a pillow between thighs
 Diet – rich in protein
 Soubces of strain such as coughing constipation an carring heavy objects should be
quoted.
 Encourage pelvic floor muscle excurses avoid infection.
 The use of cotton underwear.
 Maintain personal hygiene.
DISCHARGE PLAN:
MY patient admitted in the hospital with the complain of Placenta previa. She treated medically
and now getting relif . she is rewriting finely.
CONCLUSIONS:
Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital
must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal
morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of <36
weeks, and estimated blood loss >2000 ml.
BIBLIOGRAPHY:
1. Datta’s DC textbook of abstetrics 4 th edition 2015, new delhi , japee brother medical publisher
page no 479- 484
2. Ross 8 welson textbook of anatomy and physsialogy of female reproductive system 13 th edition
2018 page no – 487- 49
3. Https:11:www.scrbed.com.>doc>nursing.