Introduction
This paper is a literature review on placenta previa, a significant concern of the current medical practice. The review’s purpose is to discuss research addressing various aspects of placenta previa, including its epidemiology statistics, pathophysiology, general medical assessment, nursing interventions, and possible complications and safety considerations. In addition, this review involves the corresponding research of social, cultural, ethical, and legal concerns regarding the subject under discussion. This paper aims to analyze the existing literature and formulate specific suggestions for further research on placenta previa.
First of all, it is crucial to overview the current research of epidemiology statistics of placenta previa and its relevance to maternal and neonatal morbidity and mortality. According to Anderson-Bagga & Sze (2019), the anomaly affects up to 2% of pregnancies in the third trimester. Placenta previa can be a reason for postpartum hemorrhage and is associated with mothers’ and neonates’ morbidity and mortality (Anderson-Bagga & Sze, 2019). Everything described above is why placenta previa should be actively researched to help medical healthcare treat physiological abnormality.
Pathophysiology of Placenta Previa
Pathophysiology of how placenta previa develops is described in detail in current research. In the case of placenta previa, the cervix is wholly or partially covered (Anderson-Bagga & Sze, 2019). Placenta previa can be identified as low-lying, with the edge within 2-3.5 cm from the internal os, or marginal, with the edge within 2 cm from the internal os (Anderson-Bagga & Sze, 2019, para. 6). According to the research, almost 90% of low-lying placentas will have resolved by the third trimester because of placental migration (Anderson-Bagga & Sze, 2019).
In other cases, the placenta does not move: it grows towards the fundus where the blood supply is increased, meaning that the placenta’s distal portion remains at the lower uterine segment (Anderson-Bagga & Sze, 2019). Therefore, the placenta cannot regress and atrophy due to the insufficient blood supply in the lower uterine part (Anderson-Bagga & Sze, 2019). Summing up, the current literature provides a detailed description of the pathophysiological processes of the placenta’s development.
Assessment
Risk Factors
The current literature describes many risk factors associated with placenta previa, but there are significant gaps in the research section. According to Anderson-Bagga & Sze (2019), the risk factors related to placenta previa are “advanced maternal age, multiparity, smoking, cocaine use, assisted reproductive technology, history of cesarean sections, and previous placenta previa” (para. 4). However, the researchers emphasize that the underlying cause of the abnormality is not yet determined (Anderson-Bagga & Sze, 2019). Therefore, there is enough data in the current literature to analyze the risk factors when dealing with placenta previa, but further research is required to define its underlying cause.
Expected Findings
Physical examinations and diagnostic procedures help diagnose placenta previa in different pregnancy trimesters; however, various applicable practices are not equally sufficient in most cases. No evidence that any laboratory tests can help diagnose placenta previa was found in the reviewed literature. The primary physical symptom of placenta previa is vaginal bleeding which is mostly painless, yet it is not enough to diagnose placenta previa (Anderson-Bagga & Sze, 2019). Nonetheless, vaginal bleeding may present several pregnancy-related diseases or abnormalities, such as subchorionic hematoma or placental abruption (Anderson-Bagga & Sze, 2019). Therefore, if the physical examination reveals that a pregnant woman has vaginal bleeding during pregnancy, it is not a reason to diagnose placenta previa.
For the reasons mentioned above, specific diagnostic procedures are performed to diagnose the anomaly under discussion to ensure the accuracy of the diagnosis. For instance, Anderson-Bagga & Sze (2019) claim that ultrasonography can be used in the first and second trimesters to identify placenta previa, with recommended follow-up sonogram in the third trimester to see if it is persistent. The researchers admit the usefulness of magnetic resonance imagining (MRI), yet they find it costly and not more efficient compared to ultrasonography (Anderson-Bagga & Sze, 2019). However, the more recent research by Ishibashi et al. (2021) shows that MRI successfully identifies placenta previa more often than ultrasonography.
Moreover, the authors claim that MRI allows for accurately defining the type of placenta previa, meaning that using MRI is advisable even if the abnormality has been initially diagnosed with ultrasonography (Ishibashi et al., 2021). Nonetheless, independently of the technology used, the expected findings of the related diagnostic procedures are images on which placenta previa can be detected.
Nursing Interventions
The Therapeutic Procedures, Lab, and Diagnostic Studies
The therapeutic procedures, lab, and diagnostic studies for placenta previa that should be used in nursing care are primarily described in the modern literature. However, there is little data in the current research regarding specific nursing interventions for placenta previa since most studies provide general information about nursing care in pregnancy. One of the primary diagnostic studies that a nurse performs is a physical examination to assess vital signs, including temperature, heart rate, blood pressure, respiratory rate, and oxygen saturation (Carrick, 2017). In addition, nurses assist in lab tests required in cases of placenta previa, including complete blood tests, coagulation studies, and urinalysis (Carrick, 2017). Concerning therapeutic procedures, nurses’ role focuses on prenatal care (Amorim et al., 2017).
Nonetheless, everything mentioned above primarily represents nursing procedures and studies that are generally applicable in cases of pregnancy, so further research, more specific on nursing care for patients with placenta previa, is required.
Medications
The medications used in treating pregnant patients with placenta previa are widely described in the current research, including contraindications and precautions. The paramount preparation that patients with placenta previa should receive is large-bore intravenous lines which vary depending on the patient’s blood type and current condition (Carrick, 2017). However, as large-bore is a part of interventional radiology, uterine artery catheters are placed for precautions before the procedure (Anderson-Bagga & Sze, 2019). If the patient has excessive vaginal bleeding and plans to deliver via cesarean section, they “receive magnesium sulfate for fetal neuroprotection and steroids for fetal lung maturity” (Anderson-Bagga & Sze, 2019, para. 9).
It is also critical to check the patient’s drug allergies and chronic conditions to consider possible contraindications before administering the medications mentioned above (Carrick, 2017). Summing up, though the subject of medicines used for placenta previa is thoroughly researched in the current literature, further investigation is advisable to find proper preparations which are universal and have fewer contraindications.
Interprofessional Collaboration
The care of placenta previa involves many healthcare professionals from different fields, and the current literature contains enough research describing those professionals’ roles in detail. An interprofessional team gathered includes delivery and labor physicians, anesthesiologists, vascular and urology surgeons, interventional radiologists, and surgical and neonatal nurses (Anderson-Bagga & Sze, 2019). Physicians diagnose and provide patients with required therapy, an anesthesiologist administers regional or general anesthesia, and an interventional radiologist manages radiology in the patients’ treatment (Anderson-Bagga & Sze, 2019). Surgeons perform operations such as cesarean section, whereas nurses assist them in the surgery room (Anderson-Bagga & Sze, 2019). The modern literature seems to cover the topic of interprofessional collaboration fully, and further research will only be required if new healthcare professionals will be involved in the care of placenta previa.
Complications and Safety Considerations
Patient and Family Education
Placenta previa may have significant complications, which is why it is essential to research that subject and patients and their families with proper education on safety considerations. The most critical possible complication of placenta previa is postpartum hemorrhage, which is a critical blood loss and can lead to mortality and morbidity for the mother and the neonate (Anderson-Bagga & Sze, 2019). Other complications involved are preterm birth, insufficient birth weight, higher rates of blood transfusion, and others (Anderson-Bagga & Sze, 2019). The complications’ deterrence requires the patient to follow specific recommendations, such as going to the emergency room in case of vaginal bleeding, avoiding intercourse and digital examinations, and staying in bed (Anderson-Bagga & Sze, 2019).
In addition, it is advisable to know that a cesarean section is performed in uncomplicated cases; otherwise, the delivery may require a cesarean hysterectomy (Anderson-Bagga & Sze, 2019). No applicable referrals to other healthcare providers or community services in patient education were found in the reviewed literature. The patient education process seems complete in the current research, meaning that described knowledge should be enough for patients to deter complications.
Social, Cultural, Ethical, or Legal Considerations
Placenta previa is a significant concern in modern society, meaning that various social, cultural, ethical, or legal considerations might occur in treating the patient. In the case of placenta previa, such considerations are present only because of cesarean section involvement. For instance, Rimin & Nasution (2021) have found a cultural issue regarding the relationship between values in the family and the mother’s decision to choose a cesarean section over standard delivery. According to the research of Loke et al. (2019), an ethical dispute is open on whether women have the right to choose cesarean section when giving birth.
Many women want to choose the mode of birth, but the safety of the babies is often considered a top priority (Loke et al., 2019). No evidence of any legal or social issues concerning placenta previa was found in the reviewed literature. However, cultural and ethical considerations discovered are not entirely appropriate as they only concern a specific aspect of placenta previa and not the whole subject.
Conclusion and Specific Suggestions for Further Research
Based on the literature review, placenta previa is thoroughly explored, yet there are some gaps in knowledge which is worthwhile researching further. Epidemiology and pathophysiology of placenta previa are described in detail, meaning that the theoretical comprehension of the problem is intense. According to the assessment performed in the paper, the risk factors of placenta previa are appropriately analyzed, and the methods of its diagnosis prove to be accurate and efficient. The current literature contains a detailed explanation of nursing interventions for placenta previa, including the medications used and interpersonal collaboration with other healthcare professionals. The patient education process described in the existing research seems complete and understandable, and the complications related to placenta previa are listed.
However, there are significant gaps in the existing literature that should be filled to improve the treatment of placenta previa. First of all, the underlying cause of the abnormality is unknown. Furthermore, little research explicitly addresses nurses’ role in treating a patient with placenta previa, yet that does not seem critical for the subject. In addition, primary medications used in treatment have contraindications. Therefore, further research is recommended to identify the underlying cause of placenta previa and seek universal preparations. A prospective study can be conducted to explore the phenomenon of placenta previa deeper, along with a comparative study on various effective medications that have fewer or no contraindications.
References
Amorim, T. V., Souza, Í. E. D. O., Moura, M., Vasconcelos, A., & ABA Q, S. A. (2017). Nursing care perspectives in high-risk pregnancy: Integrative review. Enfermería Global, 16(2), 530-543. Web.
Anderson-Bagga, F. M., & Sze, A. (2019). Placenta previa. StatPearls. Web.
Carrick, A. I. (2017). Placenta previa. Journal of Education and Teaching in Emergency Medicine, 2(4), 1-19. Web.
Ishibashi, H., Miyamoto, M., Shinmoto, H., Soga, S., Iwahashi, H., Kakimoto, S., Matsuura, H., Sakamoto, T., Hada, T., Suzuki, R., & Takano, M. (2021). Applicability of ultrasonography for detection of marginal sinus placenta previa. Medicine, 100(1), 1-4. Web.
Loke, A. Y., Davies, L., & Mak, Y. W. (2019). Is it the decision of women to choose a cesarean section as the mode of birth? A review of literature on the views of stakeholders. BMC pregnancy and childbirth, 19(1), 1-9. Web.
Rimin, E. G., & Nasution, S. L. R. (2021). Decision making model for choosing normal maternity or cesarean section with machine learning approach. Proceedings of the international conference on health informatics, medical, biological engineering, and pharmaceutical. Science and Technology Publications. Web.