Republic of the Philippines

Isabela State University

Echague Campus
San Fabian, Echague, Isabela

A Case Study of Placenta Previa

Presented to the
Faculty and Staff of the College of Nursing
March 04, 2020

Presented By:
Nicole Cortez
Raiza Dullawan
Florjeffer Gabriel
Aldrin Matias
IJulie Ann Naval
Viell Marie Pecson
Ericka Perpose
 Rushel Samut
Stephanie Shane Santos

TABLE OF CONTENTS
I. Objectives
II. Demographic Data
III. Overview of the Disease
IV. Patient’s history
a. History of Present Illness
b. Past Medical History
c. Family History
d. Social History
e. Obstetrical History
V. Gordon’s 11 Functional Health Patterns
VI. Physical Assessment
VII. Anatomy and Physiology
VIII. Pathophysiology
IX. Course in the ward
X. Laboratory results
XI. Nursing Care Plan
XII. Drug Study
I. OBJECTIVES
General:
This presentation seeks to demonstrate the student’s knowledge regarding the general
health and disease condition of a patient with diagnosis process, possible complications,
management plan and nursing intervention.
Specific:
 Properly present the general assessment of the patient including physical assessment
and nursing health history
 Understand the pathophysiology of the case being presented
 Systematically present the data pertinent to the case being gathered.
 Efficiently provide appropriate and proper nursing diagnosis in line with the patient’s
condition and formulate nursing care plan of the problems identified. .
 Exhibit willingness to learn with positive attitude towards constructive criticism and
suggestions.

DEMOGRAPHIC DATA
DEMOGRAPHIC DATA
PATIENT’S NAME: Patient X
AGE: 44 years old
BIRTHDATE: July, 25, 1975
BIRTHPLACE: Nueva Ecija
CIVIL STATUS: Married
SEX: Female
NATIONALITY: Filipino
RELIGION: Roman Catholic
ADDRESS: Mabini, Alicia, Isabela
FATHER’S NAME: Mr. R
MOTHER’S NAME: Mrs. P
DATE OF ADMISSION: February, 25, 2020
TIME OF ADMISSION: 6:00 pm
CHIEF COMPLAINT: Vaginal bleeding with watery vaginal discharge
ROOM: OB High risk Ward
 OVERVIEW OF DISEASE

Overview of the Disease

Placenta Previa (Pilliteri)

 Placenta previa is a condition of pregnancy in which the placenta is implanted
abnormally in the uterus (Scearce & Uzelac, 2007).
 A problem of pregnancy in which the placenta grows in the lowest part of the womb
(uterus) and covers all or part of the opening to the cervix.

FOUR TYPES OF PLACENTA PREVIA (Pilliteri,)

a) Low lying placenta previa - implantation in the lower rather than in the upper portion of
the uterus.
 b) Marginal placenta previa - the placenta edge approaches that of the cervical os.
c) Partial placenta previa - implantation that occludes a portion of the cervical os.
d) Total/Complete placenta previa - implantation that totally obstructs the cervical os.

RISK FACTORS FOR PLACENTA PREVIA

 Advanced maternal age
 Increased parity/Multiparity
 Past cesarean births
 Past uterine curettage
 Multiple gestation
 Smoking/Cocaine
 Male fetus
SIGNS AND SYMPTOMS (Stoppler, 20)

Bleeding is the primary symptom of placenta previa and occurs in the majority (70%-80%) of
women with this condition.

 Vaginal bleeding after the 20th week of gestation is characteristic of placenta previa.

 Usually the bleeding is painless, but it can be associated with uterine contractions
and abdominal pain.
 Bleeding may range in severity from light to severe.

DIAGNOSTIC

 Ultrasound

THERAPEUTIC MANAGEMENT

Treatment of placenta previa depends upon the extent and severity of bleeding, gestational age
and condition of the fetus, position of the placenta and fetus, and whether the bleeding has
stopped.

 If labor has begun, bleeding is continuing, or the fetus is being compromised (measured
by the response of the fetal heart rate to contractions), birth must be accomplished
regardless of gestational age.
 Cesarean delivery (C-section) is required for complete placenta previa and may be
necessary for other types of placenta previa. 
  If the bleeding has stopped, the fetal heart sounds are of good quality, maternal vital signs
are good, and the fetus is not yet 36 weeks of age, a woman is usually managed by
expectant watching.
 Woman remains in the hospital on bed rest for close observation for 48 hours. If the
bleeding stops, she can be sent home with a referral for bed rest and home care
 Betamethasone, a steroid that hastens fetal lung maturity, maybe prescribed for the
mother to encourage the maturity of fetal lungs if the fetus is less than 34 weeks’
gestation.
 Women with placenta previa who experience heavy bleeding may require blood
transfusions and intravenous fluids. In some cases, tocolytic drugs (medications that slow
down or inhibit labor), are necessary.

PRETERM LABOR

Preterm labor is labor that occurs before the end of week 37 of gestation. It occurs in
approximately 9% to 11% of all pregnancies.

CAUSES
The cause is unknown in most women. Known causes of preterm labor are: Infections, Vaginal
bleeding, Hormone changes, Stretching of the uterus.

RISK FACTORS
Most women who have preterm labor have no known risk factors. But some things raise a
woman's risk for preterm labor. These include:

 Smoking
 Being under 20 years or over 35 years old
 Abnormally shaped uterus
 Cervix not able to stay closed
 Stress
 Having a preterm birth in the pas
 Placenta that separates from the uterus early
 Placenta in an abnormal position
 Multiple gestation

Signs and Symptoms

 Tightening of the uterus (contractions), especially more than 4 in 1 hour
 Menstrual-type cramps
 Pressure in the lower belly
 Backache
 Diarrhea
 Change in the type or amount of vaginal discharge. This might be blood, mucus, or
watery fluid.
 Gush of fluid from the vagina

DIAGNOSTICS

 Cervical exam. Your healthcare provider will check your cervix for changes.
 Transvaginal ultrasound exam. This ultrasound exam uses a device (transducer) placed
inside the vagina. The exam lets your healthcare provider measure the length of your cervix.
 Testing for amniotic fluid. This lets your provider know if the sac around the baby has
broken.

TREATMENT

 Bed rest. This can be done either at home or in the hospital

 Tocolytic medicines. These help slow or stop contractions. They may be given as a shot
(injection) or into the vein (intravenously).
 Corticosteroids. These may help the lungs of your baby grow and mature. Preterm
babies’ lungs may not be able to work on their own.
 Cervical cerclage. This procedure is used to stitch the cervix closed. It may be done
when the cervix is weak and not able to stay closed.
 Antibiotics. These are used to treat infection
 Delivery of the baby. Your provider will deliver your baby if treatments do not stop
preterm labor or if you or your baby is in danger. You may need a cesarean delivery.
NURSING HISTORY

a) Present Health History

b) Past Health History
c) Family Health History
d) Social History
e) Obstetrical History

NURSING HISTORY
HISTORY OF PRESENT ILLNESS
7 days prior to admission, the patient was walking around their neighboring to have some
exercise. According to the patient, it was approximately 30 minutes of walk before she decided
to go home. When she got home, she lay down on their bed, and fell asleep. When she woke up,
she was scared to see their bed, her clothes and lower extremities wet with blood mixed with
water from her private part of the body.
She also felt a pain around her hypogastric area. She described it as sharp intermittent
pain and rated it as 7. She then decided to go to hospital, at Tomas Cacal where she was admitted
there, and tocolysis was done. After 2 days she was discharged. She stayed in their home for 4
days for bed rest, but still there was a persistence of her condition. On February, 25, 2020, 6 pm,
she decided to go to Southern Isabela Medical Center where she was diagnosed of placenta
previa totalis through ultrasound
PAST MEDICAL HISTORY
 The patient stated that she was never been hospitalize with severe illness before even in
her childhood. When she have fever, she only take over the counter drugs, but most of the time
she just sleep and rest; then after, she feel better.
According to her, she didn’t experience any accidents in her childhood up to the present.
She don’t have any allergies to drugs and foods. She also received a vaccine before but she
doesn’t remember anymore what vaccines are those.
SOCIAL HISTORY
According to the patient she lives with her family in a core housing community in
Alicia, Isabela. She said, they have a close bond as a family. According to her, she is just a plain
housewife that is why when her husband left for work, and her children go to school, she spends
most of her time doing house chores. When she’s done with all the chores in their home, she
walk around their neighborhood and socialize with her neighbors. She don’t have any vices.
FAMILY HISTORY
According to the patient, they have history of hypertension in their family. Her mother
suffered from stroke last year, where her left side of the body was paralyzed. While in her father
side, they have history of diabetes.

OBSTETRICAL HISTORY
The patient’s OB score is G6P5(5005). She has five children, four males and one female.
Born on 1996, 1998, 2002, 2012, and 2015 from eldest to youngest. They were all born through
normal spontaneous delivery. Four of them was handled by a midwife, while the other one was
handled by a doctor. The first to third child was delivered in a house delivery setting, while the
fourth child is in RHU and the youngest is in the Hospital. According to her, she never had
prenatal check ups for her past pregnancies.
She has present pregnancy with 22 3/7 weeks age of gestation. Her last menstrual period
was on September 9, 2019. According to the patient, she is taking contraceptive pills as a family
planning method.