placenta-previa. haaaaaaaaaaaaaaaaaaahhhh

hhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh

1. PLACENTA PREVIA Fretchelle Meshley T. Panti BSN 2B

2. Placenta previa   is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus. It is the most common cause of painless  bleeding  in the third trimester of pregnancy. There are 4 types of placenta previa : Complete placenta previa . The placenta completely covers the cervix. Partial placenta previa . The placenta is partly over the cervix. Marginal placenta previa . The placenta is near the edge of the cervix. Complete placenta previa . the most severe in terms of the placenta previa spectrum. DEFINITION:

3. Pathophysiology Placental implantation is initiated by the embryo (embryonic plate) adhering in the lower ( caudad ) uterus. With placental attachment and growth, the developing placenta may cover the cervical os . However, it is thought that a defective decidual vascularization occurs over the cervix, possibly secondary to inflammatory or atrophic changes. As such, sections of the placenta having undergone atrophic changes could persist as a vasa previa . A leading cause of third-trimester hemorrhage, placenta previa presents classically as painless bleeding. Bleeding is thought to occur in association with the development of the lower uterine segment in the third trimester. Placental attachment is disrupted as this area gradually thins in preparation for the onset of labor; this leads to bleeding at the implantation site, because the uterus is unable to contract adequately and stop the flow of blood from the open vessels. Thrombin release from the bleeding sites promotes uterine contractions and leads to a vicious cycle of bleeding contractions placental separation bleeding.

4. ULTRASOUND Placenta previa is diagnosed through ultrasound, either during a routine prenatal appointment or after an episode of vaginal bleeding. Most cases of placenta previa are diagnosed during a second-trimester ultrasound exam. The initial diagnosis may be done with an ultrasound device on your abdomen. Most cases of placenta previa are diagnosed during a second-trimester ultrasound exam. The initial diagnosis may be done with an ultrasound device on your abdomen.

5. TREATMENT Patients should consent for possible blood transfusions, uterine artery embolization, and possible cesarean hysterectomy. More ultrasounds to track where the placenta is. Bed rest or hospital stay. Early delivery of the baby. This will be based on how much bleeding you have, how far along your baby is, and how healthy the baby is. Cesarean section delivery. Blood transfusion for severe blood loss. No medication is of specific benefit to a patient with placenta previa . Tocolysis may be cautiously considered in some circumstances in order to administer antenatal corticosteroids

6. Nursing Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation Episodes of bleeding Changes in fetal heart rate or fetal activity Fresh red bleeding Deficient Fluid Volume related to active blood loss secondary to disrupted placental implantation Impaired fetal gas exchange related to altered blood flow and decreased surface area of gas exchange at site at site of placental detachment STG: After 4 hours of Nursing Intervention the patient will verbalized understanding of causative factors. LTG: After 3 days of Nursing Intervention the patient will maintain fluid volume at a functional level. STG: After 4 hours of Nursing Intervention the patient will verbalized understanding of causative factors. LTG: After 3 days of Nursing Intervention the patient will maintain fluid volume at a functional level. INDEPENDENT: Monitor Vital Signs Provide comfortable environment Assess color, odor, consistency, and amount of vaginal bleeding. Weigh pads DEPENDENT: - Administer Doctor’s Order INDEPENDENT: - Monitor vital signs Position mother on her left side Restrict vaginal examination Monitor uterine contraction and fetal heart rate Provide frequent rest period and uninterrupted night time sleep DEPENDENT: - Administer Doctor’s Order INDEPENDENT Providing comfort for the patient should always be the top priority Provides information about active bleeding, and tissue loss To know the degree of blood loss INDEPENDENT: Systemic rest is important to reduce fatigue and improve strength Prevents tearing if PP is the cause of bleeding Assess of labor is present and fetal status and external system avoids trauma STG: After 4 hours of Nursing Intervention the patient verbalized understanding of causative factors. LTG: After 3 days of Nursing Intervention the patient maintained fluid volume at a functional level. STG: After 4 hours of Nursing Intervention the patient verbalized understanding of causative factors. LTG: After 3 days of Nursing Intervention the patient maintained fluid volume at a functional level.

7. RESOURCES https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768 https://my.clevelandclinic.org/health/diseases/24211-placenta-previa https://emedicine.medscape.com/article/262063-overview https://www.mayoclinic.org/diseases-conditions/placenta-previa/diagnosis-treatment