Placenta Previa And Abruptio Placenta

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ELIZALDE BERCERO JR Abruptio Placenta Placenta Previa BLESSEL JOY PADERNA BEN JER ROMANO LINDSEY CHERUB LIAO

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Placenta Previa

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Placenta Previa The abnormal implantation of placenta in the lower uterine segment, partially or completely covering the internal cervical os.

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CLASSIFICATIONS: Top Placenta Previa (Complete)  The placenta completely covers the cervix

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CLASSIFICATIONS: Partial Placenta Previa  The placenta is partially over the cervix

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CLASSIFICATIONS: Marginal Placenta Previa  The placenta is near the edge of the cervix

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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MEDICAL & SURGICAL mngt…

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S & Sx

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Abruptio Placenta

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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.

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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

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MEDICAL & SURGICAL mngt…