The labor and delivery nurse is receiving report for a pregnant client who is having a scheduled cesarean birth for placenta accreta. Which information is priority for the nurse to ascertain?

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11ecbb05_cc09_fdc9_b433_31e49dec8cf4_MD0009_00 Placenta accreta is a condition of abnormal placental adherence in which the placenta implants directly in the myometrium rather than the endometrium. Prenatal ultrasound usually detects placenta accreta, although detection can rarely occur after birth when the placenta is adherent (ie, retained placenta). A cesarean birth before term gestation at a facility with adequate resources (eg, blood products, intensive care unit) is recommended for clients with placenta accreta. The major complication of placenta accreta is life-threatening hemorrhage, which occurs during attempted placental separation. At least two large-bore IVs (eg, 18-gauge) and a blood type and crossmatch are priority concerns in case blood transfusions are necessary (Option D). (Option A) Previous cesarean birth is a risk factor for placenta accreta. Knowing the client's medical/surgical history is important but is not prioritized over the client's readiness for a blood transfusion. (Option B) A hysterectomy during cesarean birth with the placenta left in place may be required to reduce blood loss. The client should understand the implications of the procedure (ie, no future childbearing), but this is not a priority over ensuring readiness for a potential blood transfusion. (Option C) Metal and, occasionally, contact lenses should be removed prior to surgery to protect the client from injury, but this is not a priority over IV access and blood product availability. Educational objective: Placenta accreta occurs when the placenta adheres abnormally to the myometrium; attempted separation can result in life-threatening hemorrhage. Priority concerns include presence of at least two large-bore IVs and available blood products should hemorrhage occur.

The Labor and Delivery Nurse Is Receiving Report for a Pregnant