CASE STUDY

ON
PLACENTA PREVIA

Submitted to:- submitted by:-

Submitted on:-

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CASE STUDY ON PLACENTA PREVIA

HISTORY OF PATIENT
BIODATA OF PATIENT

Name : Saleema
Age : 31years
Sex : Female
Bed No. : 14
Address : Jawahar Nagar
Nationality : Indian
Religion : Muslim
Education : B. A
Occupation : House wife
Marital status : Married
Diagnosis : Placenta Previa
Dr. In charge : Dr Sameena sultan

Date of Admission : 15-07-2024

LMP : 21 -11-2023

EDD 28-08-2024
Source of information : Husband and patient

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CHIEF COMPLAINTS
Patient come to the hospital with following chief complaints: -
 Vaginal Bleeding (Painless) x 1 week
 Anorexia x 1 week
 Indigestion x 4 days
 Dyspnea x 1 week
 Swelling of legs x 2 days
PRESENT HISTORY: -
Patient is admitted in LD Hospital in antenatal ward. She is suffering from painless, recurrent
vaginal bleeding, anorexia, dyspnea and swelling of legs and feeling of weakness. She is having
fear about the fetus in her womb.
PAST HISTORY: -
Childhood Illness: -Patient is having no/H/o any disease in childhood.
Immunization: -Complete vaccination (2 doses of T.T)
Medical History: -does not having any history of disease.
 No H/o hypertension
 No H/o Diabetes Mellitus
 No H/o Abortion
 No H/o Premature labour
 No H/o still birth
Surgical History: -Patient is having no history of any kind of surgery.
PERSONAL HISTORY
Drug addiction : No history of drug addiction
Dietary habits : Non-Vegetarian
Sleeping pattern : Reduced sleeping hours
Nutritional pattern : Imbalanced nutrition due to
Anorexia
Exercise pattern : No habit of any exercise
Hygiene : Maintained adequate hygiene
Allergies : No history of allergies
Hobbies : Watching TV

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 MENSTRUAL HISTORY
Age of menarche : 14 years
Duration of menstruation : 6-7 days
Amount of menstruation : Flow Normal
Menstrual irregularities : Absent
Dysmenorrheal : Present

MARITAL HISTORY

Age of marriage : 21 years

Type of marriage : Arranged marriage
Consanguineous marriage : No consanguineous marriage
Relationship with husband : Satisfied relationship
No. of children : Three
Any sexual disorder : No any sexual disorder

PAST OBSTETRICAL HISTORY

Made of delivery : Normal vaginal delivers
Still Birth : Absent
Abortion : Absent
Year of delivery : 2019
No of birth : 2

HEALTH OF PATENTS/SIBLINGS/SPOUSE/CHILDREN
Parents : Father and mother both are not having any
disease
Siblings : Brother is suffering from hypertension
Spouse : Spouse is healthy
Children : Three of them are healthy

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 FAMILY MEDICAL HISTORY

All the family members in the family were healthy and no H/o DM, HTN or TB.

FAMILY SURGICAL HISTORY

No any family member of patient has undergone any kind of surgery.
FAMILY TREE
Sr. Name Age/Sex Relation Health Status
No.
1. Arshid Ahmad 40/M Husband Healthy

2. Salman 8/M Son Healthy

3. Snober 3/F Daughter Healthy

PSYCHOSOCAL HISTORY
Primary language : Kashmiri
Secondary language : Urdu
House (own/rent) : Own
Type of family : Joint family
Relationship of patient with family : satisfactory
Mood of the patient : Anxious
Social group of the patient : Muslim
Position of patient in the society : Respectable
Position of patient in the family : Respectable
Socio economic status of the patient : Middle class

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 ENVIRONMENTAL HISTORY

Cleanliness of House : Clean House

Type of residence : Clean village
Area : Clean
Village/city/town : Town
Hazards : No environment hazards
Pollutants : Smoke, Dusk, Dirty water
Water supply : Government Arrow system
Sanitation : Adequate
Drainage system : Adequate
Method of disposal of waste : Deep Burial
Method of cooking practices : Frying and burling
Any epidemic disease : Absent
Sanitation : Adequate
Any epidemic disease : Absent
Made of transportation : Car, public transport service

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VITAL SIGNS
Sr. Vital Signs Patient Name Normal value Evaluation
No.
1. Temperature 98º F 98.6º F Normal
2. Respiration 16 breath/min 16-20 breath/min Normal
3. Pulse 70 beats/min 72-80 beats/min Slightly/low
4. Blood pressure 120/80 mg of Hg 120/80 mm of Hg Normal

INVESTIGATIONS
Investigations Patient Value Normal Value Remarks
Hemoglobin 8 gm % 12-14 gm % Moderate
Blood group AB + Ve – Rh factor is + ve
Bleeding time 0.6 min 0.4-1.8 min Normal
Clotting time 6 min 5-10 min Normal
ESR 5 mm/ha 0-10 mm/hr Normal
HBS Ag Non-Reactive Non Reactive Normal
HCV Non-Reactive Non Reactive Normal
S. Urea 10 mg/dl 7-22.4mg/dl Normal
Uric acid 5 mg/dl 3-7 mg/dl Normal
Platelet count 1.49 lakh 1.50 – 4.50 lakh Normal
TLC 12000
DLC 62

Ultra Sound findings: -Patient is having type II placenta praevia. The arbitrary distance of
placenta from the internal OS in 7cm.
MEDICATIONS

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 Sr. Medication Dose Route Frequency Action
No.
1. Inj ceftriaxone 1 gm I/V BD Antibiotic
2. Inj Metrogyl 500 mg I/V TDS Antibiotic
3. Inj Tramodol 5 mg I/M OD Analgesic
4. Inj Methergine 1 mg I/M OD to stop bleeding
5. I/U fluids
 RL 5% I/U 24 hrs altered fluids
 DNS 5% I/U 24 hrs and electrolytes

Other supportive Therapies:-

 Provide complete bed rest to the patient.
 Provide balanced diet to the patient.
 Provide education to the patient regarding the precautions to be taken and prepare for
them.
 Provide Blood transfusion to increase blood level to prevent anemia.

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 PHYSICAL EXAMINATION

General Appearance
Look : Weak
Orientation : Oriented
Consciousness : Conscious
Nourishment : Poorly nourished
Body Built : Weak/Thin
Height : 5` 3``
Weight : 50 kg
Dress : Average
Odour : Foul smell
Hygiene : Average
Speech : Normal
Posture : Normal
Appearance : Anxious
Pain : Present

HEAD AND NECK

Scalp – Clean
Hair colour – Black
Symmetry of head – Spherical
Shape and size – Spherical and normal
Dandruff – Absent
Alopecia – Present
Scar/lesions – Absent
Headache – Absent

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Dizziness – Absent
FACE

Chloasma – Present
Colour – Pale
Turgor – Absent
Texture – Normal
Scar – Absent
EYE

Symmetry – Normal
Discharge – Absent
Eye lashes – Normal
Sclera – Pale
Conjunctive – Pallor
Periorbitaledema – Absent
Pallor – Present
Spectacles – Absent
Colour of iris – Black

NOSE
Epistaxis – Absent

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Discharge – Absent
Pulps – Absent
Sinuses – Air filled
Symmetry – Normal
EAR

Pinna – Normal
Shape and size – Normal
Location – Symmetrical
Discharge – Absent
Hearing Power – Normal
Hearing Aids – Absent
Cerumen Impaction – Absent
Crust formation – Absent
MOUTH

LIPS

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Colour – Black
Cracking – Present
Symmetry – Normal
MUCOSA
Hydration – Poor
Integrity – Normal
TONGUE

Coating – Absent
Halitosis – Absent
Colour – Whitish pink
TEETH
Colour – Pale
Dental caries – Absent
Dental infection – Absent
Gums – Black
NECK
Lymphadenopathy – Absent
Thyroid enlargement – Absent
Range of Motion – Normal
Lesions – Flexion, Extension
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Jugular vein Distension – Absent
BREAST
INSPECTION
Shape – Globular
Nipple shape – Erected
Primary areola – Present
Secondary areola – Present
Montgomery tubercles – Present
Dryness – Present
Cracked nipples – Absent
Scar formation – Absent
PALPATION
Tenderness – Present
Axillary lymph node Tait – Absent
Enlargement – Present
Masses – Absent
Lesion – Strial present
CHEST
Symmetry – Normal
Lesion – Absent
Expansion – Normal
PALPATION
Respiratory rate – 16 breath/min
Bilateral expansion – Normal
Apical pulse – 70 beats/min
PERCUSSION
Fluid Accumulation – Absent
AUSCULTATION
Wheezing sounds – Absent
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S1 and S2 sounds – Present
Heart Rate – 70 beats/min
Heart Murmurs – Absent
ABDOMEN

INSPECTION
Shape – Spherical
Abdominal girth – 10 cm
Linear Nigra – Present
Strial albican – Present
Lesion – Absent
PALPATION
Fundal grip – Present
Lateral grip – Present
Pelvic grip – Absent
Pawlick – Present
PERCUSSION
Braxton Hicks contraction – Present
GENITAL AREA
Hygiene – Average
Tenderness – Present
Chadwick sign – Present
EXTREMITIES

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Range of motion – Flexion, Extension, Rotation Present
Mobilities – Present
Homan’s sign – Normal
Leg cramps – Present
Muscle strength oedema – Normal present

PLACENTA PREVIA
Definition:-
Placenta previa is implantation of placenta over or near the internal os of the
cervix.It typically manifests as painless vaginal bleeding after 20 weeks of
gestation;The source of bleeding in placenta previa is maternal .In placenta previa
the placenta is implanted in the lower uterine segment such that is completely or
partially cover the cervix or is close enough to the cervix to cause bleeding when
the cervix is dilated or the lower uterine segment effaces.
Risk factors:-
 Multiparity
 Increased maternal age
 High altitude
 History of previous scar in the uterus
 Smoking
Types of placenta previa
 Type 1(low lying)
 Type 2(marginal)
 Type 3(incomplete or partial central)

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  Type 4(central or total)

CLINICAL MANIFESTATIONS

In Book In patient
1. Painless vaginal bleeding in the third trimester. Present
2. The bleeding is usually bright red, scant at first and Present
then become more profuse
3. The uterus size is proportionate to the period of Present
gestation.
4. The uterus feels relaxed, soft and elastic without any Present
localized area of tenderness
5. The head is floating in contrast to the period of Present
gestation.
6. Stall worthy’s sign Present

Complications:-
1. Maternal complications
 During pregnancy (APH,Malpresentation,premature labour)
 During labour(PROM,cord prolapse and intra partum hemorrhage)
 During puerperium(PPH,retained placenta and subinvolution )
2. Fetal complications
 Low birth weigh
 Asphyxia
 Intra uterine death

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ASSESSMENT AND DIAGNOSTIC FINDINGS

1. Physical examination Done

2. Abdominal examination Done
3. Sonography
 TAS
 TVS Done
 Transperineal ultrasound
 Colour Doppler flow study
4. Magnetic Resonance imaging Done
5. Internal examination Absent
6. Direct visualization during Present

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MANAGEMENT

MEDICAL MANAGEMENT
In Book In patient
1. Analgesics Inj Tramodol 5mg IM OD is given to patient.
2. Fluids RL and DNS is given to the patient.
3. Antibiotics Inj ceftriaxone 1g IV BD Inj metrogyl 500mg
IV TDS
4. Inj Methergin Inj Methergin 1mg OD is given to patient.
5. Blood replacement therapy is not given to patient.

DEFINITIVE TREATMENT
In Book In patient
1. Vaginal examination in operation
theatre followed by Not Done
a. low rupture of membrane Classical cesarean section done
b. cesarean section
2. Cesarean section without internal Done
examination.

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NURSING MANAGEMENT

Assessment and History taking:-

 Complete medical history taking
 Menstrual history
 Obstetrical history
 H/o of marital & sexual life
 Abdominal examination is done
 Check the vital sign of patient.
 Physical Head to toe examination is done
NURSING DIAGNOSIS: -
Pre-operative nursing diagnosis: -
1. Excessive vaginal bleeding related to placenta previa as evidenced by
ultrasound report.
2. Impaired fetal gas exchange related to altered blood flow and decreased
surface area of gas exchange at site of placental detachment.
3. Risk for fluid volume deficit related to bleeding.
4. Fear related to perceived threat to fetal survival.
5. Knowledge deficit related to diseased condition.
Post-operative Nursing Diagnosis
1. Pain related to surgical incision as evidenced by verbal communication.
2. Risk for infection related to surgical infusion and average personal hygiene.
3. Knowledge deficit related to post operative care as evidenced by verbal
communication.
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NURSING GOALS
Short Term Goals
 To relieve pain
 To stop vaginal bleeding.
 To support mother, spouse and family and encourage them to verbalize
feeling.
 To reduce anxiety.
LONG TERM GOAL
 To relieve the post-surgical pain.
 To rehabilitate the patient.
 Encourage client for follow up care.

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 NURSING CARE PLAN
Sr. Assessment Nursing Diagnosis Goal Nursing Intervention Implementation Rationale Evaluation
No.
1. Subjective Data- Excessive vaginal To prevent  Assess the amount  Amount of bleeding is  To gather the baseline
Patient is having a bleeding related to bleeding or to bleeding by inspection of assessed by inspection. data.
complain of vaginal placenta previa as prevent shock soaked pad.  Vaginal examination is  To prevent aggravate  The patient’s
bleeding without evidenced by  Do not perform vaginal not performed. bleeding. condition is
pain ultrasound report examination as it maintained by
aggravates bleeding. controlling bleeding.
Objective Data-  Advice the patient to take  The patient is advice to  To stop bleeding
On observation proper bed rest. take proper bed rest.
bleeding per vagina  Prepare the patient for  The patient is prepared  To prevent shock
is seen blood transfusion if for blood transfusion
needed.
2. Objective Data - Impaired fetal gas To maintain the  Assess vital signs every  Vital signs of the mother  To know the vital
Patient’s vital signs exchange related to fetal oxygen 15 minutes such as B.P, are assessed. functions
are assessed as well altered blood flow level. pulse of mother.
as fetal heart rate is and decreased  Monitor uterine  Uterine conflictions and  To know or to check the  The mother as well
monitored surface area of gas conflictions and fetal fetal heart rate are stress level on the fetus as the fetus is in
exchange heart rate. monitored good condition.
 Advice the mother to  The mother is audited to  To relieve stress on the
position on her left side. position on her left side. fetus
 Administer oxygen as  Oxygen is administered
indicated to the client.  To maintain the oxygen
level

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Sr. Assessment Nursing Diagnosis Goal Nursing Intervention Implementation Rationale Evaluation
No.
3. Subjective Data– Fear related to To relieve the  Assess the level of  Anxiety level of the  To know the condition of  The patient is feuded
The patient’s anxious perceived threat to fear of the anxiety of the mother. mother is assessed. the client. relaxed and assure
due to fear to loss the fetal survival. client  Provide parents  Information about the  To relieve the fear about fetal survival.
baby information about the nature of problem is
nature of problem provided to parents
Objective Data-  Support mother, spouse  Support is provided to the  To relieve the fear and
On Observation and family and couple and encouraged to anxiety.
patient is looking encourage them to verbalize the feelings
anxious ventilate their feelings.
4. Subjective Data - Pain related to To promote  Assess the level the pain-  Level of pain is assessed  To know the condition of
The patient is having surgical incision as comfort or to by-pain intensity scale. by pain scale. the patient.
pain on the abdomen evidenced by verbal relieve pain  Provide cool and calm  Cool and calm  To provide comfort to
communication environment to the environment is provided. the patient.
Objective Data –on patient.
observation patient is  Provide declension  Divisional therapy i.e.,  To divert the mind from
lethargic therapy to the client music is provided to the actual problem
 Administer analgesics as client.
prescribed  Inj Tramadol is given to  To relieve pain
the patient.

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5. Subjective Data - Knowledge deficit To provide  Assess the knowledge  Knowledge level of the  To know the baseline  Knowledge level of
The patient’s asking related to post knowledge to level of the patient patient is assessed. information. the client is improved
questions again and operative care as the client about  Provide information  Information about the  To promote client’s
again to know the evidenced by verbal the post about the nature of nature of problem is knowledge.
condition. communication operative care problem and care to the provided to the client.
taken.
Objective Data – On  Encourage the client to  Client is encouraged to  To ventilate her feelings
Observation patient verbalize their feelings verbalize her feelings. and auras
is not having
knowledge

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EVALUATION

SELF EVALUATION
From this case study I had got an opportunity to provide comprehensive
nursing care to the postnatal mother. During the case study I have gained
knowledge regarding placenta previa and care. I thank Mrs Sameena mam
for giving me chance to take this case for my case study during the posting.

PATIENT EVALUATION
Patient is very cooperative during the process of giving care and also, she
should follow all the instructions given by me. Mother is satisfied with my
care.General conditions of the patient are far. She is recovering from the
postnatal and postoperative period caring herself and also her baby.
I provided complete care, administered all the medications according to the
doctor prescription on time and given health education regarding family
planning techniques.

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HEALTH EDUCATON

 Explained about the need to assess the health status of the mother.
 Effective therapy to rectify the defeat.
 Early identification of any post-natal complication.
New born care: -
 Baby should be always with the mother i.e., “rooming in” technique
must be followed.
 Exclusive breast feeding i.e., demand feeding must be given.
 Immunize the baby according to the universal immunization
schedule.
Diet and sleeping Pattern: -

 The mother should spend some time each day on herself in rest and
relaxation.
 The mother should take over balanced diet rich in the calcium, iron
and protein.

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  Bowel movements must be established earlier urine output must be
normal and should be passed within 12 hours of delivery.
Personal Hygiene: -
 Complete both should be given.
 Breast care should be taken before and after feeding the baby.
 The characteristic and amount of lochia should be noted daily.
 Inform immediately if any foul smelling, abnormal bleeding per
veganism
 Menstrual hygiene must be maintained baby both should be given
daily.
Family Planning and contraception: -
 Lactating women should start 3 months after delivery, practicing the
contraceptive measures.
 Natural methods are advised until menstrual cycles are regular.
 Exclusive breast feeding provides 98% contraceptive protection for 6
months.
 Barrier methods oral contraceptives and also sterilization methods are
available.

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 PROGRESS REPORT: -
Day 1: - The patient came to the hospital with chief complaint of
vaginal bleeding, Anorexia Dyspnoea. I/V fluids are started proper bed rest
is provided. Inj metnergin is given to control the bleeding.
Day 2: - Bleeding is less than day 1 and the condition of the mother and
the fetus is well. FHR is normal.
Day 3: - Lower segment caesarean section is done. Antibiotic are given
to the patient. I/V fluids are going. Analgesics are given to the patient. New
born is healthy.
Day 4: - Patient as well as the new born is healthy some pain is present
due to surgical incision.
Day 5: - Patient condition and new born condition is progressively good
from date of admission.

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