Subjective
Date of visit
Reason for visit (prenatal diagnosis of placenta previa, vaginal bleeding)
History of present illness:
Trimester of pregnancy
Vaginal bleeding (severity, character – bright red, spotting)
Abdominal pain (if present)
Past medical history (relevant conditions, prior cesarean deliveries, uterine surgeries)
Gravidity and parity (number of pregnancies and deliveries)
Medications (current medications)
Allergies
Objective
Vital signs (temperature, heart rate, blood pressure)
Physical exam (limited if bleeding is present):
Abdominal examination (fetal size and lie, uterine tone)
Pelvic examination (may be deferred if bleeding is active)
Assessment
Placenta previa (confirmed by ultrasound)
Location of placenta (complete, partial, marginal) – based on ultrasound findings
Gestational age (fetal viability)
Amount and character of vaginal bleeding
Severity of presentation (stable vs. hemodynamically unstable)
Planned management approach (expectant management vs. delivery)
Plan
Depending on the severity, location of placenta, gestational age, and bleeding:
Expectant management (for previa and viable fetus):
Pelvic rest (avoidance of sexual intercourse)
Serial ultrasounds to monitor placental location and bleeding
Close monitoring for signs of worsening bleeding or fetal distress
Blood bank status (availability of blood products for potential hemorrhage)
Delivery planning (for previa and active bleeding, non-viable fetus):
Delivery at a facility equipped for managing hemorrhage
Planned cesarean delivery (depending on location and severity)
Blood product availability (packed red blood cells, fresh frozen plasma)
Consultation with a high-risk pregnancy specialist (Maternal-Fetal Medicine physician) may be recommended.
Education
Explain the diagnosis of placenta previa, location of the placenta, and potential complications (hemorrhage)
Discuss the planned management approach (expectant management vs. delivery) and potential risks and benefits.
Importance of adherence to activity restrictions and follow-up appointments.
Warning signs of worsening bleeding or fetal distress that require immediate medical attention.
Follow-up
Schedule for follow-up appointments:
Serial ultrasounds to monitor placental location and bleeding (for expectant management)
Delivery planning and hospitalization for cases requiring intervention
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and management of placenta previa.