Placenta

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PLACENTA PREVIA and ABRUPTIO PLACENTA

PLACENTA : 

PLACENTA A temporary organ joining the mother and fetus, the placenta transfers oxygen and nutrients from the mother to the fetus, and permits the release of carbon dioxide and waste products from the fetus. It is roughly disk-shaped, and at full term measures about seven inches in diameter and a bit less than two inches thick. The upper surface of the placenta is smooth, while the under surface is rough. The placenta is rich in blood vessels.

WARNING! : 

WARNING! The following photos are of human placenta, if you think you might be offended or grossed out please do not look now. Photos are presented for the sole purpose of study.

PLACENTAPREVIA : 

PLACENTAPREVIA

PLACENTA PREVIA : 

PLACENTA PREVIA The development of the placenta in the lower uterine segment, partially or completely covering the internal cervical os. Is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of ante-partum hemorrhage (vaginal bleeding). It affects approximately 0.5% of all labours.

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Classification of Placenta Previa

Total Placenta Previa : 

Total Placenta Previa Total placenta previa occurs when the internal cervical os is completely covered by the placenta

Partial Placenta Previa : 

Partial Placenta Previa Partial placenta previa occurs when the internal os is partially covered by the placenta.

Marginal Placenta Previa : 

Marginal Placenta Previa Marginal placenta previa occurs when the placenta is at the margin of the internal os.

Low-lying Placenta Previa : 

Low-lying Placenta Previa Low-lying placenta previa occurs when the placenta is implanted in the lower uterine segment. In this variation, the edge of the placenta is near the internal os but does not reach it.

Nursing Management : 

Nursing Management Ensure the physiologic well being of the client and fetus. Provide client and family teaching Address emotional and psychosocial needs Health Teaching Maintain a bed rest Maintain a 8 glasses of water

Nursing Interventions : 

Nursing Interventions INDEPENDENT Asses vital signs Maintain bed rest or chair rest when indicated Monitor amount and time of sleeping Position mother on her left side Restrict vaginal examination Monitor uterine contractions and FHR by external monitor Maintain position attitude toward fetal outcome. COLLABORATIVE Administer oxygen as indicated.

Signs and Symptoms : 

Signs and Symptoms Signs and symptoms of placenta previa vary, but the most common symptom is painless bleeding during the third trimester. Other reasons to suspect placenta previa would be: Premature contractions Baby is breech or in transverse position Uterus measures larger than it should according to gestational age.

Laboratory Findings : 

Laboratory Findings Trans abdominal ultrasonography confirms suspicion of placenta previa CBC: decreased Hb and HCT levels if bleeding is present

POSSIBLE COMPLICATIONS : 

POSSIBLE COMPLICATIONS Risk to the Mother include: Death Major Bleeding ( hemorrhage) Shock

RISK FACTORS : 

RISK FACTORS Previous placenta previa, caesarean delivery, or D &C e.g. used for incomplete or missed miscarriage, abortion, to treat or investigate heavy bleeding or other diagnostic purposes. Women who have had previous pregnancies, especially a large number of closely spaced pregnancies, are at higher risk.

RISK FACTORS : 

RISK FACTORS Women who are younger than 20 are at higher risk and women older than 30 are at increasing risk as they get older. Women with large placenta from twins or erythroblastosis are at higher risk. Women who smoke or use cocaine may be at higher risk.

RISK FACTORS : 

RISK FACTORS Race is a controversial risk factor, with some studies finding that people from Asia and Africa are at higher risk and others finding no difference.

ABRUPTIO PLACENTA : 

ABRUPTIO PLACENTA

Abruptio Placenta : 

Abruptio Placenta Premature separation of the normally implanted placenta after the 20th week of pregnancy, typically with sever hemorrhage. Is separation of the placenta (the organ that nourishes the fetus) from the site of uterine implantation before delivery of the fetus.

TYPES OF ABRUPTIO PLACENTA : 

TYPES OF ABRUPTIO PLACENTA

Concealed Hemorrhage : 

Concealed Hemorrhage Concealed hemorrhage – the placenta separation centrally, and a large amount of blood is accumulated under the placenta.

External Hemorrhage : 

External Hemorrhage External Hemorrhage – the separation is along the placental margin, and blood flows under the membranes and through cervix.

Nursing Management : 

Nursing Management Continuous evaluate maternal and fetal physiologic status. Asses the need for immediate delivery Provide appropriate management Provide client and family teaching Address emotional and psychosocial needs.

Nursing Intervention : 

Nursing Intervention INDEPENDENT Monitor amount of bleeding by weighing all pads. Investigate pain reports, noting location, duration, intensity (0-10 scale), and characteristics. Monitor maternal V/S and FHR through continuous monitoring. COLLABORATIVE Administer oxygen as indicated.

Signs and Symptoms : 

Signs and Symptoms Placental abruption can begin anytime after 20 weeks of pregnancy. Classic signs and symptoms of placental abruption include: Vaginal bleeding Abdominal pain Back pain Uterine tenderness Rapid uterine contractions, often coming one right after another

Laboratory Studies : 

Laboratory Studies CBC count Fibrinogen Prothrombin time Blood urea nitrogen Kleihauer-Betke Test Blood type Rh type Ultrasonography

PATHOPHYSIOLOGY : 

PATHOPHYSIOLOGY GRADE 1 – small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother. GRADE 2 – mild to moderate amount of bleeding, uterine contractions, the FHR may show signs of distress. GRADE 3 – moderate to severe bleeding or concealed bleeding, uterine contractions that do not relax, abdominal pain, low blood pressure, fetal death.

COMPARISON:PLACENTA PREVIA ABRUPTIO PLACENTA : 

COMPARISON:PLACENTA PREVIA ABRUPTIO PLACENTA