CASE STUDY

1. IDENTIFICATION DATA:
Name of the patient – Mrs. Paridhi
Age – 29 yrs.
IP no. – 543210
Address – Saraswati colony, Bombay motor, Jodhpur.
Date of admission – 20/08/21
Religion –Hindu
Education – +12
Occupation – housewife
Marital status – married for 2 year
Income – nil
Obstetrical score – G1 P0 L0 A0
Diagnosis -Placenta Previa
L.M.P - 17/01/21
E.D.D – 24/10/21
PRESENT HISTORY : - Mrs. Paridhi got admitted to Hospital, on with a complaint of vaginal
bleeding.
PAST MEDICAL HISTORY : - Mrs. Paridhi doesn’t have any significant medical illness.
Mrs. Paridhi has taken two doses of injection TT during her pregnancy period. Mrs. Paridhi
does not have any drug allergies.
PAST SURGICAL HISTORY
Mrs. Paridhi doesn’t have any history of gynecological or other operation in past.
FAMILY HISTORY: - Mrs. Paridhi is living in a nuclear family. Mrs. Paridhi is living with
her husband. All her family members do not have any hereditary or communicable diseases.
They do not have medical or surgical history even.

2. FAMILY COMPOSITION
Sr.
No
Name relationship
with the
patient
Age sex education occupation Health
status
1 Mr.Sandeep Husband 29
year
male MBA Manager in
C.company
Healthy
2. Mrs. Paridhi Self 28year female BCA Housewife Twins
Pregnancy
MENSTRUAL HISTORY: - She attended her puberty at the age of 13 years. Mrs. Paridhi does
not have any history of dysmenorrhoea or irregularity of the menstrual cycle.
CURRENT OBSTETRICAL HISTORY:-Now Mrs. Paridhi is in the 32 weeks of pregnancy
and in while doing USG reveals placental implantation site.
NUTRITIONAL HISTORY: - Mrs. Paridhi is a vegetarian and takes two meals a day. She
takes rice, ragi, maize, pulses, etc. Mrs. Paridhi does not have any food allergy.
SOCIO-ECONOMIC STATUS:-Her husband is the bread winner of the family and Mrs.
Paridhi is a housewife. There is adequate supply of water and electric facility in their house.
They practice closed drainage system. There is adequate ventilation in the surrounding
environment. They maintain good interpersonal relationship with the neighbours.
PHYSICAL EXAMINATION
General appearance:
Mrs. Paridhi is has a moderate body built. Mrs. Paridhi is groomed neatly but she looks anxious.
Posture - Mrs. Paridhi has an erect body. And does not have any abnormal body curvature like
kyphosis or scoliosis.
Skin - Mrs. Paridhi has a normal skin colour. The skin is cold and moist.
Head and face: Her hair is black in colour. It is thin and smooth in texture. The scalp is clean
and clear. Her face looks anxious.
Eyes: Her eyebrows are symmetrically present; there is equal distribution of eyelashes. Eyelids
are free of infection or sty; the conjunctiva is pink in colour. Sclera is transparent in nature. The
pupils are equally reacted to light and her vision capacity is adequate.

3. Nose: It is normal in shape and structure. The nostril is clean and it is free of discharges and
crust collection. Both the nostrils are symmetrical in opening as equally divided by the nasal
septum.
Ears: The external ears are normal in shape and structure. There free of discharges, cerumen
collection or the perforation of the tympanic membrane and infection in the internal ear.
Mouth: The lips are smooth, the teeth are white in colour and they are free of dental carries. The
gum is pink in colour and it’s free from swelling and bleeding. The tongue is pale in colour,
moist.
Neck: During inspection there is no enlargement of the thyroid gland and all the range of
movement are possible without causing any pain. There is no enlargement of the lymph node
during palpation.
Chest:
On inspection - There is symmetrical expansion of the thorax and she has a normal breathing
pattern.
On auscultation - There is no abnormal breath sound like whistling sound, rale or crackle
sound, etc. While doing examination there is no abnormal heart sound like cardiac murmur.
Breast:
Inspection: Both breasts are symmetrical. Nipples are erected. Primary and secondary areola is
present. Montgomery’s tubercles are prominent. Veins are visible and dilated.
Palpation: Thick yellow secretions (colostrum) are present. Breast is warm to tough and lump is
not presence.
Abdomen:
Inspection : skin over the abdomen is tense shiny with broad stria gravidarum; umbilicus is
everted.
Palpation:
Genitalia:
The genitalia are seen to be clean. Vaginal bleeding is not present. No any vulval edema or veins
are dilated.

4. Extremities:
The extremities were free from oedema or varicosities present. All the range of movement is
performed by the mother without any difficulty.
Back:
Mrs. Paridhi has an erect body. There is no abnormal spinal curvature like lordosis, kyphosis, or
scoliosis.
INVESTIGATION
Sr. no. Name of investigation Patient’s value Normal value Remark
1. Blood:
Hb.
Group
HIV I&II
VDRL
10.8
B +ve
Non reactive
Nil
12-14gm%
-
-
-
Normal
Normal
Normal
Normal
DISEASE ASPECT ON PLACENTA PREVIA
Definition:
The placenta is located low in the uterine cavity, partially or completely covering the
cervix.
Incidence:
About one third cases of ante-partum hemorrhage belong to placenta previa. The
incidence
ranges from 0.5-1% among hospital deliveries.
Degree / Types Of Placenta Previa:
Placenta previa is classified according to the placement of the placenta:
Type I or low lying: The placenta encroaches the lower segment of the uterus but does
not infringe on the cervical OS.

5. • Type II or marginal: The placenta touches, but does not cover, the top of the cervix.
• Type III or partial: The placenta partially covers the top of the cervix
• Type IV or complete: The placenta completely covers the top of the cervix
Etiology:
The exact cause of placenta previa is unknown. The following have been identified as
risk factor for placenta previa:
• Dropping down theory: fertilized ovum drop down and is implanted in lower uterine segment
• large placenta from twins or erythroblastosis encroaches in lower segment
• multiple pregnancy
• Advanced maternal age
Pathophysiology:
Placental implantation is initiated by the embryo (embryonic plate) adhering in the lower
(caudad) uterus. With placental attachment and growth, the developing placenta may cover the
cervical OS. However, it is thought that a defective decidual vascularization occurs over the
cervix, possibly secondary to inflammatory or atrophic changes. As such, sections of the placenta
having undergone atrophic changes could persist as a vasa previa.
A leading cause of third trimester hemorrhage, placenta previa presents classically as painless
bleeding. Bleeding is thought to occur in association with the development of the lower uterine
segment in the third trimester. Placental attachment is disrupted as this area gradually thins in
preparation for the onset of labor. When this occurs, bleeding occurs at the implantation site as
the uterus is unable to contract adequately and stop the flow of blood from the open vessels.
Clinical Manifestation / Sign And Symptoms:
• Sudden, painless, causeless and recurrent vaginal bleeding
• Bleeding is unrelated to activity often occur during sleep.
• Bleeding is unassociated with pain unless labour starts simultaneously
Diagnosis
I. Localization of placenta (Placentography):
II. clinical

6. Complication of placenta previa:
▪ Related to mother:
▪ Ante partum hemorrhage
▪ Malpresentation
▪ Premature labour
▪ Related to baby:
▪ Fetal hypoxia
▪ Low birth weight
Treatment :
Medical management:
▪ Iv fluid administration
▪ Laboratory examination: blood grouping and cross matching
▪ Assessment of blood loss by inspection of blood clots and pads.
▪ Administration of betamethasone .
▪ Bed rest, Constant fetal monitoring
✓ Surgical treatment:
▪ Amniocentesis
▪ Caesarean
Nursing management:
1. Altered Tissue Perfusion related to excessive bleeding causing fetal compromise as
evidence by vaginal bleeding.
2. Fluid volume deficit related to excessive bleeding
3. Risk for infection related to excessive blood loss
4. Anxiety related to excessive bleeding and outcome of pregnancy after episodes of bleeding
5. Knowledge deficits related to disease condition and management
6. Ensure maternal and fetal well being

7. APPLICATION OF BETTY NEUMAN'S SYSTEMS MODEL
SYSTEM MODEL- BETTY NEUMAN
A theory is a group of related concepts that propose action that guide practice. A nursing theory
is a set of concepts, definitions, relationships, and assumptions or propositions derived from
nursing models or from other disciplines and project a purposive, systematic view of
phenomena by designing specific inter-relationships among concepts for the purposes of
describing, explaining, predicting, and /or prescribing.
1. Nursing Diagnosis - based of necessity in a thorough assessment, and with consideration given
to five variables in three stressor areas.
2. Nursing Goals - these must be negotiated with the patient, and take account of patient's and
nurse's perceptions of variance from wellness
3. Nursing Outcomes - considered in relation to five variables, and achieved through primary,
secondary and tertiary interventions.
NURSING PROCESS BASED ON SYSTEM MODEL
Assessment: Neuman’s first step of nursing process parallels the assessment and nursing
diagnosis of the six phase nursing process. Using system model in the assessment phase of
nursing process the nurse focuses on obtaining a comprehensive client data base to determine
the existing state of wellness and actual or potential reaction to environmental stressors.
Nursing diagnosis- the synthesis of data with theory also provides the basis for nursing
diagnosis. The nursing diagnostic statement should reflect the entire client condition.
Outcome identification and planning- it involves negotiation between the care giver and the
client or recipient of care. The overall goal of the care giver is to guide the client to conserve
energy and to use energy as a force to move beyond the present.
Implementation – nursing action are based on the synthesis of a comprehensive data base
about the client and the theory that are appropriate to the client’s and caregiver’s perception
and possibilities for functional competence in the environment. According to this step the
evaluation confirms that the anticipated or prescribed change has occurred. Immediate and long
range goals are structured in relation to the short term goals.
Evaluation – evaluation is the anticipated or prescribed change has occurred. If it is not met
the goals are reformed.

9. Assessment Nursing
diagnosis
Nursing
objective
Planning Rationale Implementation Evaluation
Subjective data
:
Mrs. Paridhi
says that “ I am
feeling
discomfort
because of large
abdomen”.
Objective data:
Uterine size is
more than
period of
amenorrhea;
fundal height
and abdominal
girth are more
than weeks of
gestation.
Discomfort
related to
increased
uterine size
The mother
will express
minimal
discomfort.
Monitor fundal height,
weight gain unrelated to
edema
Arrange for sonography.
The theory focus on
improving nutritional
status
Administer adequate diet
rich in protein.
Administer food rich in
iron and vitamins.
Administer food rich in
fiber
Administer more fluids.
Increase in fundal height
may cause hydramnios
which may result in
preterm labour.
Assessment helps in
Recognition of discordants
growth
To improve health
condition
To improve health
condition
To improve health
condition
To prevent from shock.
Fundal height is
checked.
Weight is checked.
Assessed the dietary
pattern of the
mother.
This measure will
help in increase the
bulk of the intestine
and promotes
elimination.
This measure are
safe and natural
preventive measure.
The client
reported
having a
bowel
movement
of a
moderate
amount of
soft brown
stool every
other days..

10. Subjective
data:
The mother says
the “I am not
taking adequate
food and tell me
regarding the
balanced.”
Objective
data:
Mrs. Paridhi
looks pale
conjunctiva and
mucus
membranes.
Body wt: 45kgs
Hb: 9-2gm/%
Nutrition
status less
than body
requirement
related to less
knowledge
regarding
balanced diet.
Mrs. Paridhi
gains
knowledge
regarding
balanced
diet.
Assess the progression of
anxiety through
psychological task of
pregnancy.
Provide a quiet and calm
environment.
Teach about the
physiological changes
and response of the body
during labour process.
Explain the condition of
the fetus to the mother.
Assess the knowledge
level of the mother
Teach about the process
of normal labour .
Explain the mother after
how many days after
delivery Mrs. Paridhi can
resume for the daily
routine.
This will help in knowing
the dietary habit.
This measure will help in
softening the faces
To promote peristalsis
movement.
To aid tissue renewal and
milk production.
To know the baseline data
for planning.
To make the mother to
understand the normal
mechanism of labour.
Providing the information
about the well being of the
fetus will help to reduce
the fear and anxiety of the
mother.
Assessed the level of
fear and anxiety of
the mother by using
anxiety scale.
Provided quiet and
calm environment by
asking the visitors to
talk in a low tone.
Taught about the
physiological
changes and
response of the body
during the labour
process.
Explained the
condition of the fetus
to the mother.
Allowed the patient
to ventilate her
feeling towards
labour by listening to
what Mrs. Paridhi
Mrs Paridhi
Gained
knowledge
regarding
balanced
diet and
practices
the
instruction
in
improving
the
nutritional
status.
By
providing

11. Teach the outcome and
benefits of normal
delivery.
says. all the
above the
above
measures,

12. Health education for antenatal mother:
1. Antenatal diet: advise the mother to take food rich in vitamin, protein, minerals, iron etc.
such as green leafy vegetables and fresh fruits. Advice her to take plenty of water.
2. Antenatal hygiene: advice the mother to take daily bath. Perineal care should be
maintained. Advice her to wear tight fitted bra’s and wear cloth according to weather.
3. Antenatal exercise: advice the mother to do antenatal exercise for 10-15 mins. Advice her
to avoid stressful or heavy activities.
4. Preparation for labour: educate the mother about the process of labour and give
psychological support. Clarify the doubt of the mother related to labour.
5. Breast feedings: advice the mother about the importance of breast feeding and technique
of feedings.
6. Immunization: advise the mother about the immunization of the newborn infant. Describe
the scheduled and importance of the immunization.
7. Family planning: educate the mother regarding temporary and permanent methods of
family planning.
8. Antenatal visit: advise her for next antenatal visit and tell her importance of antenatal
visit.
9. Care of the baby: advise or educate the mother about the care of the baby such as baby
bath, cord care.

13. Summary:
My Patient came with complain of abdominal pain, back pain, and bleeding from per vagina.
Patient is primi para women. On admission she is having abdominal pain and vaginal bleeding
after she diagnosed with placenta previa. So she is admitted in antenatal ward.
Administered medicine as per doctors order and advise her to drink more oral fluids.
After providing 1days care, Patient’s health is good and reduce bleeding and indicate for
termination of delivery.
Conclusion:
During my clinical posting in Civil hospital in antenatal ward, I got chance to provide care to,
Mrs. Paridhi diagnosis of Placenta previa by this study I learn in detail about Placenta previa
definition, causes and its management. I thank my client for her cooperation and my clinical
coordinator for her valuable guidance.

14. Bibliography:-
1. Basvanthappa B.T : “TEXT BOOK OF MIDWIFERY AND
REPRODUCTIVE HEALTH NURSING”; first edition 2006, Jaypee brother
publication, New Delhi. Page no; 213-290.
2. Dutta D.C : “TEXT BOOK OF OBTETRICS” ; 6 TH
Edition , 2004;
New central book agency publication, Calcutta. Page no: 130-150.
3. Jacob Anamma : “A COMPREHENSIVE TEXT BOOK OF
MIDWIFEREEY”;1st
edition 2005; Jaypee brother medical publication; New
Delhi, page no:164-172.
4. Kumari Neelam; (2010); 1st
edition; “MIDWIFERY AND
GYNAECOLOGICAL NURSING”; S.vikas and company; Jalandhar city; Page
no :170-189.
5. Myles : “ TEXT BOOK OF MIDWIVES” ; Fourteenth edition,2003 ;
Elsevier publisher, Philadelphia. Page no; 285-287.
6. Rao Kamini “TEXT BOOK OF MIDWIFERY AND OBSTETRICS
FOR NURSES”; First edition, 2011, Elsevier publisher, Philadelphia. Page no:
277-281.
Internet resources:-
1. http://www.en.wikipedia.org/wiki/postpartumhemorrhage
2. http://www.healthline.com
3. http://www.uptodate.com/contents/postpartumhemorrhage
4. http://www.lexic.us/definition-of/postpartumhemorrhage
5. http://www.empowher.com/media/reference/postpartumhemorrhage