Obstetric Hemorrhage: Previa and Abruption

Overview

Bleeding during the late second or third trimester is a medical emergency often caused by placenta previa or abruptio placentae. Placenta previa occurs when the placenta implants near or over the cervix, while abruption is the detachment of a normally implanted placenta. Rapid assessment and intervention are required to prevent maternal and fetal morbidity.

Key nursing concepts

• Placenta previa involves the placenta covering the cervical os, requiring a Cesarean delivery.
• Abruptio placentae is the premature separation of the placenta from the uterine wall.
• Painless bleeding is characteristic of previa; painful bleeding is characteristic of abruption.
• Abruptio placentae can lead to Disseminated Intravascular Coagulation (DIC).
• Maternal stabilization and fetal assessment are the primary nursing priorities.
• Ultrasound is used to confirm placental location and rule out previa.

Important nursing considerations

• Ensure a large-bore IV (18g) is established for blood and fluid resuscitation.
• Avoid any vaginal examinations if placenta previa is suspected to prevent hemorrhage.
• Monitor maternal vital signs for early signs of hypovolemic shock.
• Measure fundal height to detect expanding intra-abdominal bleeding in abruptio placentae.
• Perform continuous fetal heart rate monitoring to assess for non-reassuring patterns.
• Administer Rho(D) immune globulin if the mother is Rh-negative after a bleeding episode.

Patient teaching

• Advise the patient on pelvic rest, meaning no sexual intercourse or douching.
• Instruct the patient to report any vaginal bleeding or abdominal pain immediately.
• Explain the necessity of a Cesarean section for complete placenta previa.

Related practice questions

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