After delivery which of the following risk associated with placenta previa?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Obstetrics & Gynaecology

Hard

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2023

Explanation

Hemorrhage is the most critical and immediate postpartum risk associated with placenta previa.
The placenta implants in the lower uterine segment, which has poor muscle content and contractility compared to the fundus.
After the placenta separates, this lower segment cannot contract and retract effectively to clamp down on the open blood vessels.
This failure of the lower segment to contract (atony) leads to potentially massive and uncontrolled bleeding from the placental site.

Option A: Disseminated intravascular coagulation (DIC) is a coagulopathy that is classically associated with abruptio placentae (placental abruption), severe preeclampsia, or a retained dead fetus, rather than placenta previa.
Option B: Chronic hypertension is a pre-existing medical condition that can complicate pregnancy but is not a postpartum complication caused by placenta previa.
Option C: While the risk of puerperal infection (sepsis) is slightly increased due to the placental site's proximity to the vagina and the high rate of operative delivery, it is not the most immediate or life-threatening risk compared to hemorrhage.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Postpartum complications of placenta previa as background academic context rather than a clinical decision trigger.
Nurses must anticipate a high risk of postpartum hemorrhage (PPH) in any patient with a known history of placenta previa, even after an uncomplicated delivery.
Immediate postpartum assessment must include vigilant monitoring of vital signs (for tachycardia/hypotension), fundal tone (for firmness), and the amount of vaginal bleeding (lochia).
Ensuring patent, large-bore IV access before delivery is a critical preparatory step for these high-risk patients.

How to Approach the Question

Identify the core concept: The question asks for a risk after delivery specifically associated with placenta previa.
Recall the pathophysiology of placenta previa: The placenta is abnormally implanted in the lower, less muscular part of the uterus.
Consider the physiological process after delivery: The placenta separates, leaving open blood vessels. The uterine muscle must contract (involution) to constrict these vessels and stop the bleeding.
Connect the pathophysiology to the post-delivery state: The lower uterine segment, being less muscular, cannot contract effectively to achieve hemostasis.
Evaluate the options based on this direct consequence: Ineffective contraction leads directly to hemorrhage. DIC, hypertension, and infection are either unrelated, pre-existing, or a much less immediate threat.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 71-94

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 18-26