Nursing Clinical Practice Guide
Clinical Scenario: You are the nurse on a labor and delivery unit. Ms. Jones, 34 weeks pregnant, is brought in by her partner. She is calm but concerned, stating, "I just started bleeding, but it doesn't hurt." You note bright red blood on her clothing. Her vital signs are stable, and the fetal monitor shows a reassuring pattern.
Nursing Intervention Strategy:- 1Immediate Action & AssessmentHelp her onto a stretcher or bed. Do not perform a vaginal exam. Apply external fetal and contraction monitors. Assess bleeding (pad count/saturation), pain, and vital signs frequently (every 15 min initially).
- 2Positioning & MonitoringPlace her in a left lateral position. Explain that this helps blood flow to the baby. Initiate continuous electronic fetal monitoring (EFM) to watch for signs of fetal compromise (late decelerations, tachycardia, loss of variability).
- 3Collaborative CareNotify the obstetrician immediately. While the patient is stable, you will assist with obtaining IV access (usually an 18-gauge catheter) and drawing labs (CBC, type and screen/crossmatch). Prepare for a possible stat ultrasound to confirm placenta location.
- 4Patient Education & SupportProvide clear, calm explanations. Educate on the importance of bed rest, including bathroom privileges only if bleeding is minimal and stable. Discuss signs that require immediate reporting (increased bleeding, pain, contractions).
Nursing Procedure & Medication Flow
* Procedure: Managing Antepartum Bleeding: 1) Ensure safety (bed rest, side-lying). 2) Assess (vitals, FHR, bleeding). 3) Monitor continuously. 4) Prepare for interventions (IV, labs, ultrasound). 5) Provide emotional support and education.
* Medication: Corticosteroids for Fetal Lung Maturity: If delivery is likely within 7 days and gestation is < 34 weeks, betamethasone 12 mg IM x 2 doses 24 hours apart may be ordered. Monitor for maternal hyperglycemia.
A Word from Your Senior Nurse
"Placenta previa is one of those OB emergencies where your knowledge directly prevents harm. That 'hands-off' approach is counterintuitive when we're trained to assess, but here, assessing the cervix could kill. Your eyes, the monitor, and your communication skills are your primary assessment tools. Trust the classic presentation—painless bright red bleeding means stop, think 'previa,' and keep your fingers out. Your calm, knowledgeable response stabilizes the situation for both your patient and her baby."