Placenta Previa Medical Management Quiz

Placenta Previa

• Vaginal delivery is considered when bleeding is minimal and the placenta previa is marginal or when labor is rapid.

Placenta Previa Medical Management

• A pediatric team should be on hand during delivery to immediately assess and treat neonatal shock, blood loss, and hypoxia.
• Continuously monitor the patient's blood pressure, pulse rate, respirations, central venous pressure, intake and output, and amount of vaginal bleeding.
• Anticipate the need for electronic fetal monitoring and assist with application as indicated.

Placenta Previa Nursing Management

• Have oxygen readily available in case fetal distress occurs.
• Administer Rhogam after every bleeding episode if the patient is Rh-negative.
• Prepare the patient and her family for a possible cesarean delivery and the birth of a preterm neonate.
• Complete bed rest is necessary.
• If the fetus isn’t mature, expect to administer an initial dose of betamethasone (Celestone) IM.
• Provide emotional support during labor.

Complications

• Possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.

Preeclampsia

• Blood pressure exceeding 140/90 mmHg or increase above baseline of 30 mm Hg in systolic pressure or 15 mmHg in diastolic pressure on two readings taken 4-6 hours apart.
• Generalized edema in the face, hands, and ankles.
• Weight gain of about 1.5 kg (3.3 lb.) per month in the second trimester or more than 1.3 to 2.3 kg (3 to 5 lb.) per week in the third trimester.
• Proteinuria 1+ to 2+, or 300 mg/dL, in a 24-hour sample.

Assessment Findings for Mild Preeclampsia

• Blood pressure exceeding 160/110 mm Hg noted on two readings taken 6 hours apart with the client on bed rest.
• Proteinuria exceeding 5 g/24 hours.
• Oliguria (less than 400 mL/24 hours).
• Headache.
• Blurred vision, spots before eyes, and retinal edema.
• Pitting edema of the sacrum, face, and upper extremities.
• Dyspnea.
• Epigastric pain.
• Nausea and vomiting.
• Hyperreflexia.

Assessment Findings for Severe Preeclampsia

• Rapid rise in blood pressure.
• Rapid weight gain.
• Generalized edema.
• Increased proteinuria.
• Epigastric pain, marked hyperreflexia, and severe headache, which usually precede convulsions in eclampsia.
• Visual disturbances.
• Oliguria.

Gestational Trophoblastic Disease/Hydatidiform Mole

• Medical management includes monitoring hCG levels once weekly until titers are negative for 3 consecutive weeks, then once monthly for 6 months, then every 2 months for 6 months.
• Contraceptive methods prevent another pregnancy until at least 1 year after all titers and X-ray findings are negative.
• Prophylactic chemotherapy methotrexate or actinomycin-D (Cosmegen) after evacuation of the uterus.
• Chemotherapy and radiation are used for metastatic choriocarcinoma.
• Monitoring for malignancy includes chest X-rays to check for lung metastasis once monthly until hCG titers are negative, then once every 2 months for 1 year.
• Assess the patient’s vital signs.
• Preoperatively, observe for signs of complications, such as hemorrhage and uterine infection, and vaginal passage of vesicles.