{
  "name": "Placenta Previa & Abruptio Placentae",
  "slug": "placental-disorders",
  "url": "https://nursingplex.com/care-plans/placental-disorders",
  "category": "Maternal & Newborn (OB)",
  "summary": "Third-trimester bleeding emergencies; no vaginal exams, volume support and fetal watch.",
  "nursing_diagnoses": [
    "Risk for bleeding",
    "Ineffective tissue perfusion",
    "Anxiety"
  ],
  "overview": [
    "Placenta previa and abruptio placentae are the two classic causes of third-trimester bleeding, and telling them apart drives the entire nursing response. In previa the placenta implants over or near the cervical os; in abruption a normally implanted placenta separates from the uterine wall before birth.",
    "Previa presents with painless, bright red bleeding and a soft, non-tender uterus. Abruption presents with sudden, sharp abdominal or back pain and a rigid, board-like, tender uterus; bleeding may be dark red or concealed behind the placenta, so blood loss can be far worse than what is visible.",
    "In both, no vaginal examination is performed until previa is excluded by ultrasound — a digital exam can perforate the placenta and cause catastrophic hemorrhage. Care centers on volume support, continuous fetal monitoring, readiness for emergency cesarean, and DIC surveillance, particularly with abruption."
  ],
  "key_facts": [
    {
      "label": "Previa hallmark",
      "text": "Painless bright red bleeding with a soft uterus, often after 20 weeks."
    },
    {
      "label": "Abruption hallmark",
      "text": "Painful bleeding with a rigid, tender uterus; may be concealed with minimal external blood."
    },
    {
      "label": "Absolute rule",
      "text": "No vaginal or rectal exams and nothing per vagina until placenta previa is ruled out."
    },
    {
      "label": "Delivery route",
      "text": "Complete previa always requires cesarean; abruption usually requires urgent delivery."
    },
    {
      "label": "DIC risk",
      "text": "Abruption releases thromboplastin and is the leading obstetric trigger for disseminated intravascular coagulation."
    },
    {
      "label": "Rh factor",
      "text": "Give Rh immune globulin to Rh-negative women with any antepartum bleeding."
    }
  ],
  "nursing_priorities": [
    "Stabilize maternal circulating volume and prevent hypovolemic shock.",
    "Maintain fetal oxygenation and detect distress immediately.",
    "Prevent any action that could worsen bleeding.",
    "Prepare for emergency cesarean and neonatal resuscitation.",
    "Detect coagulopathy early.",
    "Reduce maternal and family fear."
  ],
  "assessment": {
    "subjective": [
      "Onset, amount and color of bleeding and any preceding trauma, cocaine use or intercourse",
      "Presence, character and location of pain; back pain in posterior abruption",
      "Change in fetal movement",
      "Fear for the baby and for her own safety"
    ],
    "objective": [
      "Vital signs with trending pulse and blood pressure; late hypotension after significant loss",
      "Pad counts and weighed blood loss; uterine tone by palpation",
      "Fundal height measurement — increasing height suggests concealed abruption bleeding",
      "Continuous fetal heart monitoring for late decelerations, tachycardia, minimal variability or sinusoidal pattern",
      "Hemoglobin, hematocrit, platelets, fibrinogen, PT/PTT, D-dimer and type and crossmatch",
      "Urine output as a perfusion marker, with indwelling catheter in unstable patients"
    ],
    "related_factors": [
      "Abnormal placental implantation over the cervical os",
      "Premature separation from hypertension, trauma, cocaine use, smoking or uterine overdistention",
      "Prior cesarean, prior previa, advanced maternal age and multiparity",
      "Consumption of clotting factors after placental separation"
    ]
  },
  "goals": [
    "The client will maintain systolic blood pressure above 90 mmHg, pulse under 100 and urine output above 30 mL/hr.",
    "The fetus will maintain a reassuring heart rate pattern until delivery.",
    "The client will not experience additional bleeding provoked by care activities.",
    "Coagulopathy will be recognized and treated before clinical bleeding from other sites.",
    "The client and family will state the plan of care and warning signs."
  ],
  "interventions": [
    {
      "title": "Immediate stabilization",
      "points": [
        "Place on strict bed rest in a left lateral position and keep NPO in case of surgery.",
        "Start two large-bore IVs, give isotonic fluids and send type and crossmatch for at least two units.",
        "Give oxygen by non-rebreather at 8–10 L/min for non-reassuring tracings.",
        "Keep the emergency cesarean, blood products and neonatal resuscitation team on standby."
      ]
    },
    {
      "title": "Bleeding surveillance",
      "points": [
        "Weigh pads and linens to quantify loss rather than estimating.",
        "Mark fundal height with a pen and remeasure hourly to detect concealed bleeding.",
        "Palpate uterine tone frequently; a rigid, painful uterus signals abruption.",
        "Never perform vaginal exams; post the restriction at the bedside."
      ]
    },
    {
      "title": "Fetal and coagulation monitoring",
      "points": [
        "Maintain continuous external fetal monitoring and report loss of variability, late decelerations or bradycardia.",
        "Administer betamethasone for fetal lung maturity if gestation is under 34 weeks and delivery can be delayed.",
        "Monitor for DIC: oozing from IV sites, gum bleeding, petechiae, falling fibrinogen and platelets.",
        "Give Rh immune globulin to Rh-negative women as ordered."
      ]
    },
    {
      "title": "Expectant management of stable previa",
      "points": [
        "For a stable preterm previa with no active bleeding, support modified activity, pelvic rest and close outpatient follow-up.",
        "Teach immediate return for any bleeding, contractions or leaking fluid.",
        "Encourage iron supplementation and a high-fiber diet to avoid straining."
      ]
    }
  ],
  "patient_teaching": [
    "Nothing goes in the vagina: no intercourse, tampons, douching or self-examination.",
    "Report any bleeding, contractions, abdominal pain or decreased fetal movement at once.",
    "Explain why cesarean birth is planned for complete previa.",
    "Teach daily fetal movement counting and when to call.",
    "Avoid smoking and cocaine, which are major abruption risk factors.",
    "Keep emergency transportation arranged and know the fastest route to the hospital."
  ]
}