Slide 1: ELIZALDE BERCERO JR Abruptio Placenta Placenta Previa BLESSEL JOY PADERNA BEN JER ROMANO LINDSEY CHERUB LIAO
Slide 2: Placenta Previa
Slide 3: Placenta Previa The abnormal implantation of placenta in the lower uterine segment, partially or completely covering the internal cervical os.
Slide 4: CLASSIFICATIONS: Top Placenta Previa (Complete)
The placenta completely covers the cervix
Slide 5: CLASSIFICATIONS: Partial
Placenta Previa
The placenta is partially over the cervix
Slide 6: CLASSIFICATIONS: Marginal
Placenta Previa
The placenta is near the edge of the cervix
Slide 7: PATHOPHYSIOLOGY: Predisposing Factors:
Age (35-40)
Gender
Race (nonwhite ethnicity)
Heredofamilial Predisposing Factors:
Previous abortion
Previous placenta previa
Multiple births
Endometritis
VBAC (vaginal birth after cesarean delivery)
Lifestyle (smoking, etc.) Previous abortion
Previous placenta previa
Multiple births
Endometritis
VBAC (vaginal birth after cesarean delivery)
Lifestyle (smoking, etc.) Damage to
endometrium Defective decidual vascularization exists (2 to inflammatory or atrophic changes) Incomplete development of the fibrinoid layer
Slide 8: IMPLANTATION Adherence of embryo (embryonic plate) in the lower uterus Attachment of placenta to lower uterine segment Accreta Covers cervical opening as placenta Inc. in size Total P. Previa
Partial P. Previa
Marginal P. Previa
Slide 9: ONSET OF LABOR Thinning of the area (implantation site) Disruption of placental attachment Uterus unable to contract Unable to stop flow of blood from the open vessels
Slide 10: Bleeding at the implantation site Release of Thrombin from the bleeding sites Promote contraction Promote contraction FOLLOWS A VICIOUS CYCLE:
Bleeding – Contractions – Placental separation - Bleeding
Slide 11: NSG DXs & NSG INTERVENTIONS Altered Tissue Perfusion related to excessive bleeding causing fetal compromise Frequently monitor mother and fetus
Administer IV fluids as prescribed
Position on side to promote placental perfusion
Administer oxygen as facemask as indicated (8-10 per minute)
Slide 12: NSG DXs & NSG INTERVENTIONS Fluid volume deficit related to excessive bleeding Establish and maintain a large-bore IV line, as prescribed and draw blood for type and screen for blood replacement
Position in a sitting position to allow weight of fetus to compress the placenta and decrease bleeding
Maintain strict bed rest during any bleeding episode
Prepare woman for a cesarean delivery
Administer blood or blood products protocol per institutional policy
Slide 13: NSG DXs & NSG INTERVENTIONS Risk for infection related to excessive blood loss Use aseptic technique when providing care
Evaluate temperature q4h unless elevated; then evaluate q2h
Evaluate WBC and differential count
Teach perineal care and hand washing techniques
Assess odor of all vaginal bleeding or lochia
Slide 14: NSG DXs & NSG INTERVENTIONS Anxiety related to excessive bleeding Explain all treatments and procedure
Encourage verbalization of feelings by patient and family
Provide information on a CS delivery
Discuss the effects of long-term hospitalization or prolonged bed rest
Slide 15: NSG DXs & NSG INTERVENTIONS Fear related to outcome of pregnancy after episodes of bleeding Explain all treatments and procedure
Encourage verbalization of feelings by patient and family
Provide information on a CS delivery
Slide 16: ASSESSMENT Determine the amount and type of bleeding
Inquire as to presence or absence of pain in association with the bleeding
Record maternal and fetal VS
Palpate for the presence of uterine contractions
Evaluate laboratory data on Hct and Hgb
Assess fetal status with continuous fetal monitoring
Never perform a vaginal examination when pt is bleeding
Slide 17: COMPLICATIONS Placenta accreta
Immediate hemorrhage, with possible shock and maternal death
Increased risk for anemia secondary to increased blood loss and infection secondary to invasive procedures to resolve bleeding
Intrauterine growth restriction (IUGR)
Congenital anomalies
Fetal mortality resulting from hypoxia in utero and prematurity
Slide 18: MEDICAL & SURGICAL mngt…
Slide 19: S & Sx
Slide 20: Abruptio Placenta
Slide 21: Abruptio Placenta Is premature separation of the implanted placenta before the birth of the fetus
Hemorrhage can be either occult or apparent. With an occult hemorrhage, the placenta usually separates centrally, and a large amount of blood is accumulated under the placenta. When the apparent hemorrhage is present, the separation is along the placental margin, and blood flows under the membranes and through the cervix. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding
Slide 22: PATHOPHYSIOLOGY: Predisposing Factors:
Age (> 35y.o)
Gender
Heredofamilial Predisposing Factors:
Previous abruptio placenta
PIH
Abdominal trauma
Smoking
Cocaine use
Chorioamnionitis Damage in small arterial vessels in the basal layer of decidua Bleeding Splits decidua, leaving a thin layer attached to the placenta Destruction of the placental tissues OCCULT APPARENT
Slide 23: Hematoma formation Compression of the basal layer Obliteration of the intervillous space Destruction of the placental tissues Impaired exchange of respiratory gases and nutrients Visible Bleeding Concealed Bleeding Blood reaches the edge of the placenta Blood passes through the membranes of amniotic sac
Slide 25: Blood passes through the membranes of amniotic sac Port wine discoloration
of discharges
( PATHOGNOMONIC SIGN) NOTE:
Small amount of blood goes out to the vagina (not an indication of the severity of condition)
Slide 26: NSG DXs & NSG INTERVENTIONS Ineffective tissue perfusion (placental) related to excessive bleeding, hypotension, and decreased cardiac output, causing fetal compromise Evaluate amount of bleeding by weighing all pads. Monitor CBC results and VS
Position in the left lateral position, with the head elevated to enhance placental perfusion
Administer oxygen through a snug face mask at 8-12L per minute
Evaluate fetal status with continuous external fetal monitoring
Prepare for possible CS delivery if maternal or fetal compromise is evident
Slide 27: NSG DXs & NSG INTERVENTIONS Instruct patient on the cause of pain to decrease anxiety
Instruct and encourage the use of relaxation technique to augment analgesics
Administer pain medications as needed and as prescribed Acute Pain related to increase uterine activity
Slide 28: NSG DXs & NSG INTERVENTIONS Establish and maintain a large-bore IV line, as prescribed and draw blood for type and screen for blood replacement
Evaluate coagulation studies
Monitor maternal VS and contractions
Monitor vaginal bleeding and evaluate fundal height to detect an increase in bleeding Fluid volume deficit related to excessive bleeding
Slide 29: NSG DXs & NSG INTERVENTIONS Use aseptic technique when providing care
Evaluate temperature q4h unless elevated; then evaluate q2h
Evaluate WBC and differential count
Teach perineal care and hand washing techniques
Assess odor of all vaginal bleeding or lochia Risk for infection related to excessive blood loss
Slide 30: NSG DXs & NSG INTERVENTIONS Inform the woman and her family about the status of herself and the fetus
Explain all procedures in advance when possible or as they are performed
Answer questions in a calm manner, using simple terms
Encourage the presence of a support person Fear related excessive bleeding procedures and unknown outcome
Slide 31: ASSESSMENT Determine the amount and type of bleeding and the presence or absence of pain.
Monitor maternal and fetal vital signs, especially maternal BP, pulse, FHR, and FHR variability.
Palpate the abdomen
Note the presence of contractions and relaxations between contractions (if contractions are present)
If contractions are not present assess the abdomen for firmness
Measure and record fundal height to evaluate the presence of concealed bleeding.
Prepare for possible delivery.
Slide 32: COMPLICATIONS Maternal shock
Anaphylactoid syndrome of pregnancy
Postpartum hemorrhage
Acute respiratory distress syndrome
Sheehan’s syndrome
Renal tubular necrosis
Rapid labor and delivery
Maternal and fetal death
Prematurity
Slide 34: MEDICAL & SURGICAL mngt…