Placenta previa

Placenta previa

1. ميحرلا نحمرلا الله مسب
َل َكَناَحْبُس ْاوُلاَقآَنَل َمْلِع ّلِإ
ُميِلَعْلا َتْنَأ َكّنِإ آَنَتْمّلَع اَم
ُميِكَحْلا
ميظعلا للها قدص
ةروسةرقبلاةيأ32
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 1

2. High risk pregnancy
Thursday, April 5, 2018
Dr. Soad Abd El salam Ramdan 2

3. 3
•Chairman of obstetrics &woman health
nursing department
•Pre. Vice of dean for students &Education
Affair
Faculty of nursing
BenhaUniversity
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan

5. Learning objectives:-
Describe causes of bleeding in early pregnancy.
Apply nursing care plan for woman with
bleeding in late pregnancy.
Enumerate types of associated medical
problems during pregnancy.
Describe the nurses responsibilities in relation
to various types of associated medical problems
during pregnancy.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 5

6. Bleeding during pregnancy
Bleeding
Late
pregnancy
Accidental
hge.
Placenta
previa
Early
pregnancy
Abortion
Ectopic
pregnancy
Vesicular
mole
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 6

7. Bleeding in late
pregnancy
Thursday, April 5, 2018
Dr. Soad Abd El salam Ramdan
7

8. 2-Ante partum Hemorrhage:
Bleeding in late pregnancy
(After 20 weeks Gestation)
Definition
Antepartum hemorrhage is defined as
bleeding occurring from the genital tract
after the 24th week of pregnancy, and
before the birth of the infant.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 8

9. Classification
◘Placenta previa: –
Inevitable hemorrhage occurs from separation of an
abnormally situated placenta. The placenta lies partly
or wholly in the lower uterine segment.
◘Abruptioplacenta: –
bleeding occurs from the premature separation of a
normally situated placenta.
◘Extraplacentalbleeding: –
is vaginal bleeding from some other part of the
birth canal e.g. cervical polyp, varicose veins of the
vulva, etc.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 9

10. Complications of Antepartum
Hemorrhage
◘Maternal Risks:
Hemorrhagic shock.
Acute renal failure.
Disseminated intravascular
coagulation (DIC)
Increased risk for
postpartum hemorrhage.
Severe anemia.
◘Fetal Risks:
Prematurity and
birth asphyxia.
Intrauterine fetal
death.
Thursday, April 5, 2018Dr. SoadAbdEl salamRamdan 10

11. 1-Placenta Previa
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 11

12. Placenta Previa
Definition
This is a condition in
which the placenta is
partly or totally
implanted over the
lower uterine
segment.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 12

14. Prevalence of Placenta Previa
Occurs in 1/200 pregnancies that
reach 3
rd
trimester

15. Causes:-
No specific cause can be detected, but theories
1-Large placenta
Placenta membrana (large and thin)
Placenta of twins pregnancy
Syphilis
Some cases of D.M
low implantation of placenta in L.U.S: due
to delayed development of trophoblast
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 15

16. Placenta previaIncidence
increase with:
Previous uterine instrumentation (D & C)
Multiparty
Maternal age over 40 years
Multiple gestation astwins pregnancy
Prior placenta previa
Uterine fibroid
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17. Degrees:-
◘Placenta previa
lateralis: [type I]
The lower part of
the placenta is
implanted over the
lower uterine
segment, but does
not reach the
internal os.
◘Placenta previa
marginalis: [type II]
Part of the placenta
is implanted over the
lower uterine
segment and its
margin reaches the
internal os, but does
not cover it
completely.
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18. ◘Incomplete central
placenta previa: [type
III]
The placenta covers the
closed or incompletely
dilated internal os
eccentrically, but with
further dilatation. The
placenta does not cover
it completely when it is
closed, but covers it
incompletely when the
osis dilated.
◘Complete central
placenta previa: [type
IV]
The whole placenta is
implanted over the
lower uterine segment,
with the internal os
located at the center of
the placenta. Thus, the
placenta covers the
internal oscompletely
even when it is fully
dilated.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 18

20. Diagnosis 1-C/P –Placenta Previa
* Symptoms:
Cardinal symptom is painless
,causeless and recurrent 2
nd
or 3
rd
trimester vaginal bleeding

21. Signs:
acute: hgic. Shock
a. General Exam :blood loss chronic: anemia
b. Abdominal Examination:
1-uterus :
1-Fundallevel equal to period of amenorrhea
2-Not tender , not hard
3-Easy palpable fetal parts
4-Audible F.H.S , malpresentaion
5-No engagement
6-Supra pubic fullness if placenta interior

22. C-P.Vcontraindicated but if
necessary
Under Precaution:
1-Available blood transfusion
2-In operating theatre
3 Under aseptic condition
4-Under general anesthesia
5-When active treatment is indicated

23. Investigation:
1-Laboratory
Hematocrit or complete blood count
Blood type and Rh
Coagulation tests

24. Ultrasound –Placenta Previa
it’s the most useful test to confirm
diagnosis
Full bladder can create false appearance of
anteriorprevia
MRI
Test for fetal maturity and fetal well being

25. Effects of Placenta Previaon
Pregnancy and Labor
◘It lowers the general
resistance of the patient.
◘Abnormal
presentation and
position.
◘Premature labor.
◘Prolonged labor.
◘More chance of
surgical intervention.
◘Increased risk of
lacerations.
◘Placenta may be
morbidly adherent.
◘Postpartum
hemorrhage.
◘Fetal malformation.
◘High incidence of
fetal hypoxia and
mortality.
◘Maternal shock.
◘Maternal death.
Thursday, April 5, 2018Dr. Soad Abd El salam Ramdan 25

26. Management of Placenta
Praevia
Management of placenta praeviadepends
on:
◦The amount of bleeding
◦The condition of mother and fetus
◦The degree of the placenta
◦The duration of pregnancy
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27. Therapeutic Management:
❖Birth must be accomplished regardless of
gestational age;
▪if labor has begun,
▪bleeding is continuing,
▪fetus in distress
❖Managed by expectant watching:
If the bleeding has stopped,
•the fetal heart sounds are of good quality,
•maternal vital signs are good,
•and the fetus is not yet 36 weeks of age
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28. Complication of Placenta Previa
Maternal complication
1-Abnormal presentation and position.
2-Premature labor.
3-Prolonged labor.
4-More chance of surgical intervention.
5-Placenta may be adherent: Placenta accreta,
increta, or percreta
6-Postpartum hemorrhage
7-Maternal shock and maternal death

29. Fetal complication
Fetal malformation.
High incidence of fetal hypoxia
Increase incidences of perinatal
mortality and morbidity.
Increase incidences of prematurity

30. Nursing care
1-Assessment:
Withtheclient’sadmissiontothehospital,thenurse
beginswithanassessmentofthebleeding.Necessary
historydataincludegravidity,parity,EDD,generalstatus,
bleeding(quantity,precipitatingevent,andassociated
pain),vitalsignsandfetalstatus.Abdominalassessment
revealsasoftrelaxed,nontenderuteruswithnormal
tone.LaboratorystudiesincludeCBC,determinationof
bloodtypeandRhfactor,coagulationprofileand
possibletypeandcrossmatchfor2packedredblood
cells.

31. 2-Nursing diagnosis:
Nursing diagnosis for placenta
previa include focus on alterations
in hemodynamic status, knowledge
deficits, fears and anxiety of the
woman and her significant others,
and fetal status

32. 3-Planning:
Theplanmustrelatespecificallytothe
client’sclinicalandnursingdiagnosis
*Thewomanwillidentifyanduseavailable
supportsystems.
*Thewomanwillnotdevelop
complications.
*Thewomanwillcarryherpregnancyto
termornearterm.
*Thewomanwillgivebirthtohealthy
infant.

33. 4-Implementation:
Ifconservativemanagementisused,nursing
carefocusesonaccurateassessmentsand
appropriatereferrals.Theclientisinstructedon
theimportanceofbedrestandtheneedtoreport
anyfurtherspottingorbleeding.Maternalvital
signswillbeassessedasindicatedbythewoman’s
condition.Seriallaboratoryvalueswillbeevaluated
forthepresenceoffallinghemoglobinand
hematocritlevelsandchangesincoagulation
studies.Fetalwell-beingwillbeevaluatedAny
indicationoffetalcompromisewillbereported
immediatelytothephysician.

34. Ifactivemanagementisundertaken,thenurse
willcontinuouslyassessmaternalandfetalstatus
whilepreparingtheclientforsurgery.Laboratory
studieswillincludeCBC,DICprofile,and
possibletypeandcrossmatchingforpackedred
bloodcellsmaternalvitalsignswillbeassessed
frequentlyfordecreasingbloodpressure,rising
pulserate,changesinlevelofconsciousness
(L.O.C)and/oroliguria.Fetalassessmentwillbe
maintainedbycontinuouselectronicfetal
monitoring(E.F.M)toassessforsignsofhypoxia.

35. 5-Evaluation:
The nurse can be assured that care was effective
to the degree that goals for care have been met.
* She does not develop complications.
* She carries her pregnancy to term or near term.
* She gives birth to a healthy infant.

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