| Pathology | Etiology | Assessment | Nursing Care Plan/Implementation |
|---|
| Placenta Previa |
| Types: | More common with multiparity, advanced maternal age | Painless, brightred vaginal bleeding | No vaginal or rectal examinations or enemas |
| Marginal—low-lying | Fibroid tumors | Usually manifests in 8th month |  Bedrest ( high Fowler’s if marginal previa) |
| Partial—partly covers internal cervical os | Endometriosis | Postpartum: signs of hemorrhage, infection | |
| Complete—covers internal cervical os | Old uterine scars Multiple gestation | | - Maternal vital signs q4h, or prn
- Note character and amount of bleeding Emotional support
|
| Abruptio Placenta |
| Types: | Preeclampsia/eclampsia | Pain: sudden, severe | Position: supine; elevate (right) hip |
| Partial—small part separates from uterine wall | - Before birth of second twin
- Traction on cord
| - Abdomen: rigid
- Uterus: very tender to touch
| - Monitor: vital signs, blood loss, fetus
|
| Complete—total placenta separates from uterine wall | - Rupture of membranes
- High parity
| - Fetal hyperactivity; bradycardia, death
| - I&O (anuria, oliguria; hematuria)
|
| Retroplacental—bleeding (concealed) | - Chronic renal hypertension
| - Shock: rapid, profound
- Port-wine amniotic fluid
| Prepare for surgery Emotional support |
| Marginal—occurs at edges; external bleeding | - Oxytocin induction/augmentation of labor
- Cocaine use
- Trauma
| - Signs of DIC
- Postpartum: signs of atony, infection, pulmonary emboli
| |