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A complete blood count is essential to monitor the client's hemoglobin and hematocrit levels during active or intermittent bleeding. Serial assessments allow the nurse to quantify the impact of blood loss and identify the need for iron supplementation or transfusion. A significant drop in these values can indicate occult bleeding or a loss of hemodynamic compensation. This laboratory measure provides a baseline for maternal oxygen-carrying capacity.

Prothrombin time and activated partial thromboplastin time are critical for monitoring the client's coagulation status, especially if a large hemorrhage occurs. Massive blood loss can trigger consumptive coagulopathy, leading to disseminated intravascular coagulation where clotting factors are exhausted. Monitoring these parameters ensures that the medical team can provide fresh frozen plasma or cryoprecipitate if the coagulation cascade fails. This is a vital safety measure for preventing uncontrolled systemic bleeding.

Type and crossmatch are mandatory for any client with placenta previa to ensure that compatible blood products are immediately available. In the event of a catastrophic bleed, there is no time for the traditional crossmatching process, which can take 45 to 60 minutes. Having units of packed red blood cells ready reduces the risk of prolonged maternal hypotension and shock. This preparation is a cornerstone of emergency obstetric care.

Doppler ultrasound is used to assess the umbilical artery flow and ensure that the fetus is receiving adequate perfusion despite placental malposition. This diagnostic tool can detect placental insufficiency before it manifests as non-reassuring heart rate patterns on a monitor. It is particularly useful in clients with suspected placenta accreta, where the blood flow patterns may be abnormally high or turbulent. This provides a non-invasive assessment of fetal-placental well-being.

The primary diagnostic finding in placenta previa is the visualization of the placenta covering or near the internal cervical os. Transvaginal ultrasound provides high-resolution images that allow the clinician to classify the previa as complete, partial, or marginal based on the percentage of coverage. If the placental edge is within 2 cm of the os, it is clinically managed as a previa due to the high risk of hemorrhage. This finding confirms the anatomical malposition that defines the condition.

A soft, non-tender uterine wall is a hallmark clinical finding that distinguishes placenta previa from abruptio placentae. In previa, the bleeding originates from the placental site without significant myometrial irritation or intrauterine pressure elevation. On ultrasound, the uterine wall appears thin and relaxed, consistent with the clinical lack of abdominal rigidity. This finding is crucial for differential diagnosis, as it indicates that the bleeding is not caused by a premature separation of a normally implanted placenta.

Visualizing an intact umbilical cord insertion is a standard part of the ultrasound evaluation to rule out vasa previa or velamentous insertion. In placenta previa, the cord typically inserts into the placental mass normally, although the mass itself is malpositioned. Ensuring that the vessels are not crossing the os unprotected (vasa previa) is vital because fetal exsanguination occurs much more rapidly if the vessels themselves are ruptured. This assessment confirms the stability of the fetal circulatory attachment.

Ultrasound may reveal possible signs of placenta accreta spectrum, which is a frequent and dangerous co-morbidity of placenta previa. Sonographic markers include the loss of the retroplacental clear zone, abnormal placental lacunae, and hypervascularity at the bladder-uterine interface. This is especially relevant if the client has a history of previous cesarean sections, as the placenta can grow into the old surgical scar. Early identification of invasion allows for complex surgical planning and prevents catastrophic postpartum hemorrhage.