A 35-year-old G1P0 at 36 weeks presents with painless bright red vaginal bleeding and ultrasound-confirmed complete placenta previa. She is hypotensive (90/60 mmHg), tachycardic (110 bpm), and the fetus has minimal heart rate variability. This is an obstetric emergency requiring immediate preparation for cesarean delivery.
Key Clinical Points
- Never perform a digital vaginal exam in known or suspected placenta previa; it can cause catastrophic hemorrhage.
- Maternal hypotension and tachycardia indicate significant blood loss; initiate large-bore IV access and fluid resuscitation as a temporizing measure.
- Fetal minimal variability suggests uteroplacental insufficiency; continuous electronic fetal monitoring is essential.
Nursing Priorities
- Prepare for emergency cesarean section: Notify the surgical team, anesthesia, and neonatology; gather equipment and complete preoperative checklist.
- Maternal stabilization: Administer oxygen via non-rebreather mask, position left lateral tilt to maximize uteroplacental perfusion, and monitor vital signs every 5–15 minutes.
- Blood product readiness: Type and crossmatch for at least 2–4 units of packed red blood cells; anticipate massive transfusion protocol activation.
Interventions to Avoid
- Do not administer oxytocin or prostaglandins, which can increase uterine tone and worsen placental separation.
- Avoid Trendelenburg positioning as a primary intervention; it does not address the source of bleeding and may compromise ventilation.