Placenta Previa—Nursing Care and Management in Maternity
Practice
Introduction
Placenta previa is a pregnancy complication in which the placenta partially or
completely covers the cervical opening. It can cause painless vaginal
bleeding in the second or third trimester and poses significant risks to both
mother and fetus. Prompt diagnosis and careful monitoring are essential.
Maternity nurses play a central role in assessment, patient education, care
planning, and emotional support throughout pregnancy and delivery.
Understanding Placenta Previa
Types of Placenta Previa:
1. Complete previa: Placenta entirely covers the cervix.
2. Partial previa: Placenta partially covers the cervix.
3. Marginal previa: Placenta is located near the cervix but does not
cover it.
4. Low-lying placenta: Placenta implants in the lower uterine segment,
close to the cervix.
Placenta previa affects about 1 in 200 pregnancies, with higher incidence
among women who have had previous cesarean sections, uterine surgeries,
multiple pregnancies, or advanced maternal age.
Signs and Symptoms
Sudden, painless vaginal bleeding (usually bright red) after 20 weeks
gestation
No uterine tenderness or contractions
Fetal heart rate typically remains normal unless severe hemorrhage
occurs
Nurses must differentiate placenta previa from abruptio placentae, which
presents with painful bleeding and uterine rigidity.
Diagnosis and Monitoring
Ultrasound (transabdominal or transvaginal) confirms the
placental location.
MRI may be used in complex cases or to rule out placenta accreta.
Regular monitoring helps assess placental migration as the uterus
grows.
Nursing Interventions: Antepartum Period
1. Patient Education
Instruct on pelvic rest—no vaginal exams, intercourse, or heavy lifting
Explain signs of worsening bleeding
Prepare for potential hospitalization or early delivery
2. Home Monitoring
For stable, mild cases, monitor bleeding, fetal movements, and
maternal vitals at home
Encourage immediate reporting of any spotting or cramping
3. Hospital Care (if needed)
Bed rest and fetal monitoring
IV fluids and lab work (CBC, blood type, coagulation studies)
Administration of corticosteroids to promote fetal lung maturity if
preterm delivery is likely
Rh immunoglobulin (RhoGAM) if the mother is Rh-negative
4. Psychosocial Support
Reassure the patient and family
Address fears around bleeding, preterm birth, or cesarean section
Facilitate counseling if needed
Intrapartum Care
Most women with placenta previa require cesarean delivery, especially in
complete or partial cases.
Nurse’s Role During Delivery:
Prepare for cesarean and potential hemorrhage
Ensure blood products are available
Monitor maternal and fetal vitals continuously
Maintain a calm, reassuring environment
Support the patient emotionally before and after surgery
Postpartum Nursing Care
Monitor for postpartum hemorrhage and signs of infection
Assess incision site and manage pain
Support early bonding and breastfeeding (if stable)
Educate on implications for future pregnancies (e.g., risk for placenta
accreta or repeat previa)
Case Example
A 32-year-old woman at 30 weeks gestation presents with painless vaginal
bleeding. Ultrasound confirms complete placenta previa. She is admitted for
monitoring. Nurses provide bed rest instructions, administer corticosteroids,
and monitor fetal well-being. At 36 weeks, she undergoes a planned
cesarean without complications. Postpartum, the nurse monitors bleeding,
supports breastfeeding, and provides discharge education on recovery.
Nursing Theories Applied
Roy’s Adaptation Model
o Encourages nurses to assess how women adapt to the physical
and emotional stress of restricted activity and possible
complications.
Watson’s Theory of Human Caring
o Reinforces the need for empathy, presence, and holistic support
during high-risk pregnancy experiences.
Orem’s Self-Care Deficit Theory
o Highlights the nurse’s role in assisting the patient during periods
of limited independence (e.g., hospitalization, bed rest).
Challenges in Placenta Previa Management
Maintaining maternal-fetal safety without over-medicalizing stable
cases
Balancing patient autonomy with the need for activity restriction
Managing unexpected hemorrhage or emergency delivery
Ensuring access to emotional support for anxiety or trauma
Nurses are essential in helping patients navigate these challenges through
clear communication and timely intervention.
Conclusion
Placenta previa is a serious condition that demands vigilant nursing care,
especially as pregnancy progresses. Maternity nurses must provide
education, emotional support, monitoring, and collaboration with medical
teams to ensure safe outcomes. By applying both clinical knowledge and
compassionate care, nurses help women facing placenta previa maintain
confidence, safety, and dignity throughout the experience.
References
American College of Obstetricians and Gynecologists (ACOG). (2020).
Placenta Previa: Practice Bulletin No. 192. https://www.acog.org
Roy, C. (2009). The Roy Adaptation Model (3rd ed.). Pearson.
Watson, J. (2008). Nursing: The Philosophy and Science of Caring. University
Press of Colorado.
Orem, D. E. (2001). Nursing: Concepts of Practice (6th ed.). Mosby.
Mayo Clinic. (2024). Placenta Previa. https://www.mayoclinic.org
