Question

Shannon is 28 weeks’ pregnant and is admitted to the hospital with what the patient describes as painless bleeding. She is placed on the external fetal monitor; the baby has a baseline of 130 bpm with moderate variability. What do you suspect is happening?  Describe the clinical manifestations of this condition and discuss expected management of care for this patient. Select one nursing diagnosis and R/T statement for the patient.

Answer 1

it is the blleding from th genital tract after 28 weeks of pregnancy and before tehe end of the second stage of labour.

In this case ..it is placenta praevia.

The placenta is partially or totaly attached to the lower uterine segment..it is most common in multiparas and in twin preganancy due to large size of the placenta.

• In this condition,what is happening means,

progressive stretching of the lower uterine segment normally occurs during 3rd trimester and labour, but the inelestic placenta cannot stretch with it. this leads to inevitable seperation of the part of the placenta with unavoidable bleeding. the closer to term, the greater is the amount of bleeding.

• clinical manifestations

symptoms

1. causeless, painless and recurrent bright-red vaginal bleeding
2. it is causeless but may follow sexual intercourse or vaginal examination
3. it is painless, but may be associated with labour pains.
4. it is recurrent , but may occur once in slight placenta pravia lateralis.

signs

1. shock develops if there is acute severe blood loss
2. anemia
3. abdominal examination: the uterus is corresponding to the period of amenorrhoea,relaxed and not tender.
4. the fetal parts and heart sound can be easily detected.

Treatment

• assessment of the patients conditions, general and abdominal examination and no vaginal pack, only a sterile vulval pad is applied.
• antishock measures as pethidine IM, fluids and blod transfusion may be given in the way to the hospital if bleeding is severe.
• atleast 2 units of cross matched blood should be available