Placenta Previa & Abruptio Placentae Nursing Care Plan
Third-trimester bleeding emergencies; no vaginal exams, volume support and fetal watch.
Quick answer
A Placenta Previa & Abruptio Placentae nursing care plan centers on stabilize maternal circulating volume and prevent hypovolemic shock; maintain fetal oxygenation and detect distress immediately; prevent any action that could worsen bleeding. Priority nursing diagnoses are Risk for bleeding, Ineffective tissue perfusion, Anxiety. The plan below gives assessment cues, measurable goals, 4 intervention sets with rationales, and patient teaching.
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 numbers to know
Previa hallmark
Painless bright red bleeding with a soft uterus, often after 20 weeks.
Abruption hallmark
Painful bleeding with a rigid, tender uterus; may be concealed with minimal external blood.
Absolute rule
No vaginal or rectal exams and nothing per vagina until placenta previa is ruled out.
Delivery route
Complete previa always requires cesarean; abruption usually requires urgent delivery.
DIC risk
Abruption releases thromboplastin and is the leading obstetric trigger for disseminated intravascular coagulation.
Rh factor
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.
Nursing assessment
Subjective data
- 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 data
- 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
Key nursing diagnoses
Goals and expected outcomes
- 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.
Nursing interventions and rationales
Immediate stabilization
- 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.
Bleeding surveillance
- 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.
Fetal and coagulation monitoring
- 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.
Expectant management of stable previa
- 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 and family 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.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Placenta Previa & Abruptio Placentae questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Maternal & Newborn (OB) care plans
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Care plan writing guides
Common questions
What are the nursing diagnoses for Placenta Previa & Abruptio Placentae?
Priority nursing diagnoses for Placenta Previa & Abruptio Placentae: Risk for bleeding; Ineffective tissue perfusion; Anxiety.
What are the nursing interventions for Placenta Previa & Abruptio Placentae?
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. Weigh pads and linens to quantify loss rather than estimating. Mark fundal height with a pen and remeasure hourly to detect concealed bleeding.
What are the nursing care goals for Placenta Previa & Abruptio Placentae?
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.
What should you assess in a patient with Placenta Previa & Abruptio Placentae?
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; 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