The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for Which risk is associated with placenta previa?

1. A

   Infection

2. B

   Hemorrhage

3. C

   Chronic hypertension

4. D

   Disseminated intravascular coagulation

Appeared in: PGIMER Sangrur NO - 2023

Explanation

• Placenta previa is the implantation of the placenta in the lower uterine segment.
• The lower uterine segment has fewer muscle fibers compared to the upper segment (fundus).
• After delivery, the lower segment cannot contract effectively to compress the blood vessels at the placental site.
• This ineffective contraction, known as uterine atony, is a primary cause of postpartum hemorrhage (PPH).

Why Other Options Were Wrong

• Option A: While infection is a potential postpartum complication, it is not the most immediate and life-threatening risk directly resulting from the pathophysiology of placenta previa.
• Option C: Chronic hypertension is a pre-existing medical condition that complicates pregnancy; it is not a postpartum complication caused by placenta previa.
• Option D: Disseminated intravascular coagulation (DIC) is a rare complication of placenta previa. It is much more strongly associated with placental abruption.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Postpartum complications associated with placenta previa to guide bedside assessment, documentation, and the next nursing action.
• Nurses must recognize that a history of placenta previa automatically places a postpartum patient in a high-risk category for PPH.
• Immediate postpartum assessment should prioritize monitoring for signs of hemorrhage: frequent checks of fundal tone, lochia amount, and vital signs are critical.
• A firm fundus can be misleading in placenta previa, as bleeding can originate from the non-contractile lower segment while the upper fundus remains firm. Therefore, monitoring vaginal bleeding is paramount.

How to Approach the Question

• First, identify the key condition in the question stem: 'placenta previa'.
• Recall the definition and pathophysiology of placenta previa: the placenta is located in the lower uterine segment.
• Think about the postpartum period and the physiological process of stopping bleeding after placental delivery, which is uterine contraction (involution).
• Connect the pathophysiology of placenta previa to the postpartum process. The lower uterine segment is less muscular and cannot contract effectively.
• Evaluate the options based on this connection. Ineffective contraction of the placental site leads directly to hemorrhage.
• Eliminate the other options: Infection is a risk but secondary. Chronic hypertension is a pre-existing condition. DIC is rare and more common with abruption.

Concept Tested & Keywords

• Concept Tested: Postpartum complications associated with placenta previa.
• Stem keywords: postpartum unit, placenta previa, newborn infant, risk
• Lead-in keywords: monitor the client for which risk
• Clinical cues: History of placenta previa is a major risk factor for postpartum hemorrhage.

Question ID

Qhv9mI7JBKdBwvtORHvfw8

Copy ID

Reference Book

E6 Obstetrics Williams pp. 71-94, 65-88