L7: at risk preg pt2 Flashcards
Placental abruption types
- partial separation (apparent hemorrhage)
- Partial separation (concealed hemorrhage)
- Complete separation (concealed hemorrhage)
Causes of abruption
- Pregnancy induced hypertension (most common)
- previous abruption (risk inc with multiple abruptions)
- Trauma
- Cigarette smoking
- Cocaine or crack
- Premature rupture of membrane
- Multiparity
- old age
- short cord
- uterine malformation
Apparent vs concealed hemorrhage
- Apparent: blood leaves via vagina
- Concealed: blood forced from fetal membranes into amniotic sac and myometrial muscle fibers.
- causes in uterine tone and irritability
S&S of apparent placental abruption
- Vaginal bleeding w/ hemorrhage ranging from mild, mod, severe
- Hypertonic uterus (moderate - no resting tone or tetanic uterus (severe - board like tone)
- abd / back pain ranging in severity
S&S of concealed placental abruption
- No or minimal vaginal bleeding
- Hypertonic uterus
- Uterine or abdominal pain & tenderness
- Uterus sensitive to palpation; - irritability
- Rapid inc in uterine size with rigidity
- Acute fetal compromise
- Hypovolemia and shock
- DIC
- Bloody amniotic fluid
Emergency management for mod to severe abruption
- Replace blood loss
- crystalloid solution
- volume expanders or immediate transfusion
- Continuously monitor the fetus
- Oxygen administration
- Draw bloodwork for type and screen, CBC, platelet count, PT,INR, PTT & fibrinogen
- Correct coagulation defect if present
•Fibrinogen replaced with cryoprecipitate or fresh frozen plasma
•Platelets given if surgery is planned
When is fetus not expedited in cases of abruption
abruption moderate to severe
Fetus > 36 weeks
Fetal compromise
When is the fetus not expedited in cases of abruption
- Abruption moderate to severe
- Fetus > 36 weeks
- Fetal compromise
What is placental previa
Case where placenta overlies cervix
classification of placenta previa
- Placenta previa
- Low-lying: placental edge is 2cm within cervical os
- Normal: is within more than 2cm of os
Diagnosis of previa
Dx via transvaginal U/S at 18 wk then confirmed at >32wks
- it is common for placenta to be near os early in the pregnancy and will migrate away from the os. This is why we do not diagnose it earlier
Risks associated with Placenta previa
- Mortality
- Prematurity
- Malpresentation
- Small for gestational age
- congenital abnormalities
S&S of PP
Atenatal Bleeding/hemorrhage bc of Digital exam, intercourse, contractions
- Painless, bright red bleeding, - shortened cervix which increases bleeding risk
- Recurrent, variable amount of bleeding
- Uterine will be Soft, relaxed, non-tender uterus, normal tone
- Vital signs may be normal or may look off bc of shock
- Fetal compromise
If mom is bleeding do not perform a vaginal exam. T or F
T: notify provider
