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Flashcardlet > 1229 Exam 5: Placenta Previa and Abruptio > Flashcards

1229 Exam 5: Placenta Previa and Abruptio Flashcards

1
Q

Life support system for the unborn baby
Supplies oxygen and nutrients to the fetus
Removes wastes
Produces hormones
Protects from infections/harmful substances

A

Placenta

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2
Q

Placenta has implanted in the lower uterine segment near or over the internal cervical os
Occurs in about 1 out of every 500 births or 0.5%
3 Types:
-Complete
-Partial
-Marginal

A

Placenta Previa

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3
Q

When placenta completely covers the internal os

A

Complete Placenta Previa

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4
Q

Incomplete coverage of the internal os by the placenta

A

Partial Placenta Previa

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5
Q

Placenta is near the edge of the internal os (2-3 cm from internal os)
Also called low-lying placenta in the second trimester
-Because it can move upward as the pregnancy progresses

A

Marginal Placenta Previa

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6
Q

Cause of Placenta Previa

A

No actual cause known

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7
Q

Risk Factors for Placenta Previa

A 
Endometrial scarring from
-Previous Placenta Previa
-Previous C-Section
-Suction Curettage
--From miscarriage or abortion
-Multiple gestation
-Multiparity
Maternal age over 35
African or Asian ethnicity
Smoking
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8
Q

Anytime vaginal bleeding occurs after 20 weeks of gestation
Bleeding often occurs as the lower uterine segment stretches and thins during the third trimester of pregnancy. This causes the area of the placenta over the cervix to bleed.
Bleeding is bright red

A

Previa should be suspected

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9
Q

Signs and Symptoms of Previa

A

Painless, bright red vaginal bleeding
VS may be normal
-Can loose 40% blood volume before S/S shock
-Clinical picture and decrease urine output are more accurate
Soft, relaxed non-tender uterus with normal tone
Fundal height usually greater than gestational age
-Low placenta hinders descent of presenting part

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10
Q

S/S continued

A

Leopold’s maneuvers may reveal breech or transverse position
-Manual manipulation to define fetal position
Most common symptoms:
sudden, painless, minimal to severe bright red vaginal bleeding during third trimester

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11
Q

How is Previa diagnosed?

A

Ultrasound can diagnose and pinpoint location of pre via
Transabdominal ultrasound
Transvaginal ultrasound
-Used with exact location cannot be seen with abd ultra
-BUT…only if no other option
Vaginal exams are avoided d/t risk of causing more bleeding
If vaginal exam must be done:
-Anticipate need for immediate cesarean birth
-Will usually do in a surgical suite set up for a c-section
-Hemorrhage can occur during the exam

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12
Q

Possible Complications for Previa

A 
Premature Rupture of Membranes
Preterm labor/birth
Blood transfusion reactions
Over-infusion of fluids
Abdominal placental attachments
Vasa previa
-Umbilical Vessels below the presenting part
C-section related complications
-Surgery related trauma
-Anesthesia complication
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13
Q

Complications continued

A 
Postpartum hemorrhage
Anemia
Thrombophlebitis
Infection
Fetal risks:
-Fetal death r/t preterm labor/birth
-Malpresentation
--Breech/transverse
-Congenital anomalies
-Small for gestational age
--Poor placental exchange 
--Hypovolemia from blood loss and maternal anemia
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14
Q

Management of Previa

A 
Depends
-on the stage of pregnancy
-on the severity of the bleeding
-on the condition of baby and mother
Cesarean section is usually recommended
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15
Q

Active Management

A 
Admit to L&D
Continuous fetal/uterine monitoring
MOM
-Carefully watch BP, HR, LOC, Output
C-Section if term and bleeding
-37 weeks
Partial/Marginal Previa
-With minimal bleeding
-May attempt vaginal birth
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16
Q

Expectant Management

less than 36 weeks, not in labor, bleeding mild or stopped

A 
Admit to hospital
Continued fetal/uterine monitor - BPP & NST
Bed rest with BRP
Monitor bleeding
-# of pads/weigh pads
-No vag or rectal exams
Ultrasound q 2-3 days
Monitor labs
-H&H, coagulation factors
IV infusion or saline lock
-Blood and blood products
Antepartum steriods
-Betamethasone (< 34 weeks)
17
Q

Treatment for previa

A

Home Care

  • Must be stable
  • No evidence of active bleeding
  • Must be able to return to hospital immediately for active bleeding
  • Close supervision by family and friends
  • Taught to assess fetal and uterine actively and bleeding
  • Must avoid intercourse, douching, and enemas
  • Limit activity according to physician
  • Keep all appointments for fetal testing/lab assess/prenatal care
  • Perinatal home care nurse will visit
18
Q

treatment continued…

A

Previa is always considered a potential emergency
-massive blood loss resulting in hypovolemic shock can occur rapidly
Possible continued hemorrhage after birth due to inability of the uterus to contract in that location
-Upper portion of uterus
Has interfacing muscle bundles around vessels to the placenta
Forms a “living ligature” to stop the bleeding after birth
This is absent in the lower part of the uterus

19
Q

Prognosis for Previa

A

Probable outcome
-Very good if the condition is managed appropriately
Fetal Distress
-Not usually present unless a cord accident occurs
-Or blood loss heavy enough to cause maternal shock
-Or placenta abruptio

20
Q

Other Types of Previas

A

Vasa Previa
Placenta accreta
Placenta increta and percreta

21
Q

Umbilical vessels are not covered with Wharton’s jelly so they are fragile and cross the internal os below the presenting part
Teraring and hemmorrhage is frequently seen with ROM

A

Vasa Previa

22
Q

Placenta implants too deeply into uterine wall

A

Placenta accreta

23
Q

Placenta that imbeds itself even more deeply into uterine muscle
Or through the entire thickness of the uterus
Often extending into nearby structures such as the bladder

A

Placenta increta and percreta

24
Q

The detachment of part of all the placenta detaches from the implantation site in the uterine wall, partially or almost completely after 20 weeks and before delivery
Mild cases:
-only cause a few problems
Severe cases:
-can deprive the fetus from oxygen and nutrients
-also cause bleeding in the mother
-endangers both mother and baby

A

Abruptio Placenta

25
Q

Diagnosis of Abruptio Placenta

A

Physical Exam-Question
Symptoms reported
-amount of bleeding and pain
Ultrasound
Apt test
-Detects fetal blood in blood vaginal show
–on nursing unit, mix vaginal blood with Na+ Hydroxide
–Fetal blood remains pink/maternal turns brown
Kleihauer-Betke stain
-Detects transplacental hemorrhage
–fetal to maternal bleeding
Sometimes diagnosed post-delivery
-when clotted blood is found behind the placenta

26
Q

What causes placental abruption?

A

Exact cause unknown

  • Hypertension
  • Infection involving the uterus
  • Cocaine use
  • > 35 years of age
  • Cigarette smoking
  • Multiple births
  • Abdominal trauma
  • Inherited clotting disorders
  • Abnormalities of the uterus or umbilical cord
  • Premature rupture of the membranes
27
Q

Signs and Symptoms of Abruptio

A 
Dark red vaginal bleeding
Abdominal pain
Uterine discomfort and tenderness
Symptoms can occur without vaginal bleeding
-Blood is trapped behind the placenta
Nausea, thirst, faint feeling
Decreased fetal movement
Blood in amniotic fluid
Board-like abdomen
28
Q

Small amount of vaginal bleeding
Some uterine contractions
No fetal distress or hypertension in mom

A

Grade 1 Abruption

29
Q

Mild to moderate amount of bleeding
Uterine contractions
Fetal heart rate may show signs or distress

A

Grade 2 Abruption

30
Q

Moderate to severe bleeding or concealed bleeding
Uterine contractions that do not relax (tetany)
Low BP, abd pain, fetal death

A

Grade 3 Abruption

31
Q

Treatment for Abruption

A

There is no treatment to stop placental abruption or reattach the placenta
Once abruption begins, treatment depends on:
-Condition of the fetus
-The amount of bleeding
-Gestational age of the fetus
Most of the time a C-Section will be done

32
Q

Hospital Care

A 
Tx depends on severity of blood loss and fetal maturity and status
Mild: < 36 weeks and not in distress
-Hospitalized
-Closely observed for bleeding and labor
-EFM, NST, BPP
-Condition deteriorates-immediately delivery
-Corticosteroids
-? vaginal birth
33
Q

Hospital Care continued…

A

Cesarean Section: Fetal Compromise, severe hemorrhage, coagulopathy, poor labor process, or increasing uterine resting tone

  • IV, vital signs frequent
  • Lab studies
  • EFM
  • Foley
  • Emotional support
34
Q

Maternal Complications

A

Hemorrhage and shock
Couvelaire Uterus (Bleeding into uterine wall)
-Purplish and copper colored uterus
-Ecchymotic and contractility is lost
-Shock can occur even with min/mod blood loss
Disseminated intravascular coagulation
-Hyperstimulated clotting, blocking small vessels resulting in necrosis of organs and then hemorrhage from clotting factors being used up
Poor blood flow with damage to kidneys/brain
Infection
Postpartum hemorrhage

35
Q

Disseminated Intravascular Coagulation (DIC)

A 
Never a primary diagnosis
S/S:
-Unusual bleeding from venipuncture, IM
-Nose/gums bleeding
-Tachycardia/diaphoresis
-Petechiae under BP cuff
36
Q

DIC

A 
Lab tests:
-H&H
-PT, PTT, Bleeding time
-Clotting factors (platelets, fibrinogen)
Treatment:
-Stop underlying cause
-Platelets, FFP
-IV heparin
-Exchange transfusion
37
Q

Complications associated with Abruption

A 
Increases the risk of premature births
-birth before 37 wks gestation
-contributes to about 10% of premature births
Premature babies:
-are increased risk for health problems
-lasting disabilities
-death
Increases risk of poor fetal growth and stillbirth
Perinatal Mortality 20-30%
Maternal Mortality approaches 1%
38
Q

How to reduce the risk of Abruption?

A

Teach mom

  • Prenatal care
  • Keep blood pressure under control
  • Avoid cigarettes and cocaine
  • Wear a seat belt
  • Dx/Tx for blood clotting disorders

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