Module 07: Premature Cervical Dilation, Placenta Previa, and Abruptio Placenta Flashcards
Under this complication, the cervix dilates prematurely and cannot hold the fetus until term.
Premature Cervical Dilatation or Incompetent Cervix
Incompetent cervix is characterized as what
Painless cervical effacement and dilatation in early mid t-trimester resulting to the expulsion of products of conception.
Premature cervical dilatation is also known as the most common cause of what?
HABITUAL ABORTION
What are the risk factors for premature cervical dilatation?
(A) Increased maternal age
(B) Congenital structural defects
(C) Trauma to the cervix
(D) Repeated D&C
What are the signs and symptoms of incompetent cervix?
(A) Pink stained vaginal discharge or bloody show
(B) Increased pelvic pressure
(C) PROM
(D) Contractions mid trimester
(E) Presence of painless cervical dilatation
What is the surgical management of incompetent cervix?
CERVICAL CERCLAGE (Purse string sutures are placed in the cervix by the vaginal route
under regional anesthesia)
What are the two types cervical cerclage?
(A) SHIRODKAR
(B) MCDONALD
When is cervical cerclage done?
14 to 16 weeks of gestation
What is the goal of cervical cerclage?
To strengthen the cervix and prevent it from dilating.
Under this type of cervical cerclage, nylon sutures are placed horizontally and vertically across the cervix and pulled tight to reduce the cervical canal to a few millimeters in.
MCDONALD’S (TEMPORARY)
Under this type of cervical cerclage, Sterile tape is the threaded in a purse-string manner under the submucosal layer of the cervix and sutures in place to
achieve a closed cervix.
SHIRODKAR (PERMANENT)
What is the nursing management after cerclage?
(A) Place the woman in bed rest for 24 hours.
(B) Observe for bleeding, uterine contractions, and rupture of BOW.
(C) If BOW ruptures, sutures are removed.
(D) If uterine contractions occur, give ritodine to stop.
(E) Restrict activities, including coitus, for two weeks.
(F) Place in slight or modified trendelenburg position.
What are the two types of third trimester bleeding?
(A) Placenta Previa
(B) Abruptio Placenta
The placenta is found in the posterior part of the uterus.
What is the normal weight of the placenta?
500 GRAMS
What is the normal diameter of the placenta?
15 to 20 CM
What is the normal thickness of the placenta?
1.5 to 3.0 cm
The placenta weighs approximately what fraction of the fetus’s weight?
1/6th
What is the normal number of cotyledons in the placenta?
15 to 28
This type of bleeding is characterized as the abnormal implantation of placenta in the lower uterine
segment, partially or completely covering the internal cervical os.
PLACENTA PREVIA (multiple pregnancy and gestational diabetes can be one of the roots of this)
What are the symptoms of placenta previa based on the case studied?
(A) Bright red vaginal bleeding
(B) Spotting
(C) Non-tender abdomen
Under this type of placental implantation, the placenta completely covers the cervix.
Top Placenta Previa (Complete)
In top placenta previa, is normal vaginal delivery possible? YES OR NO?
NO (When the placenta comes out first, the oxygen supply is then cut off leading to fetal hypoxia)
Under this type of placental implantation, the placenta is partially over the cervix.
Partial Placenta Previa
In partial placenta previa, is normal vaginal delivery possible? YES OR NO?
Normal vaginal delivery is not possible since a part of the placenta still blocks the cervix.
Under this type of placental implantation, the placenta is near the edge of the cervix. This entails close monitoring for bleeding of the mother.
Marginal Placental Previa
In marginal placenta previa, is normal vaginal delivery possible? YES OR NO?
May be subjected to double set-up (normal vaginal delivery then ready CS delivery set-up)
What should be assessed in placenta previa?
(A) Determine the amount and type of bleeding
(B) Inquire as to presence and absence of pain related to bleeding
(C) Record maternal and fetal VS
(D) Palpate the presence of uterine contractions
(E) Assess fetal status
(F) Never perform vaginal examination
(G) Evaluate Hct and HgB
What type of bleeding is characterized by bright red blood and is painless?
Placenta previa (due to insufficient rupture to stimulate prostaglandins).
What are different non modifiable risk factors?
(A) Age (35-40 years old women)
(B) Gender
(C) Race (non-white ethnicity)
(D) Heredofamilial
(E) Previous abortion
(F) Previous placenta previa
(G) Multiple births
(H) Vaginal birth after cesarean delivery (VBAC)
(I) Endometritis
Explain the pathophysiology of Placenta Previa.
(A) Damage to endometrium
(B) Defective decidual vascularization (inflammatory or atrophic changes)
(C) Incomplete development of the fibrinoid layer (implantation)
(D) Adherence of embryo (embryonic plate) in the lower uterus
(E) Attachment of placenta to lower uterine segment
(F) Placenta accreta (remains attached)
(G) Covers cervical opening as placenta increases in size (total, partial, marginal)
Onset of Labor
(H) Thinning of the implantation site
(I) Disruption of placental attachment
(J) Uterus unable to contract
(K) Inability to stop blood flow from open vessels
(L) Bleeding at the implantation site
(M) Release of thrombin from the bleeding sites
(N) Promotes contraction (no pain)
(O) Vicious cycle: Bleeding → Contraction → Placental separation → Bleeding
What is the priority nursing intervention for altered tissue perfusion related to excessive bleeding?
Position the patient on her side to promote placental perfusion.
Why should the mother and fetus be frequently monitored in cases of altered tissue perfusion?
To assess fetal well-being and detect signs of compromise due to inadequate oxygenation.
What oxygen therapy is indicated for patients with altered tissue perfusion?
Administer oxygen via facemask at 8-10 L/min as prescribed.
What IV intervention is necessary for altered tissue perfusion?
Administer IV fluids as prescribed to maintain circulatory volume.
What is the priority nursing intervention for fluid volume deficit due to excessive bleeding?
Position the patient in a sitting position to allow fetal weight to compress the placenta and reduce bleeding.
What are other nursing management for fluid volume deficit due to excessive bleeding?
(A) Maintain strict bed rest during any bleeding episode
(B) Administer blood or blood products protocol per institutional policy
(C) Establish and maintain a large- bore IV line as prescribed and draw blood for type and screen for blood replacement
(D) Prepare woman for cesarean delivery
What is the priority nursing intervention for infection prevention in placenta previa?
Assess the odor of all vaginal bleeding or lochia.
What are other nursing interventions for infection prevention in placenta previa?
(A) Teach perineal care and handwashing techniques
(B) Use aseptic technique when providing care
(C) Evaluate WBC and differential count
How frequently should maternal temperature be monitored?
Every 4 hours unless elevated, then every 2 hours.
It occurs when the placenta adheres deeply to the uterus, leading to excessive bleeding and possible hysterectomy.
Placenta accreta
How does placenta percreta differ from placenta increta?
Placenta percreta penetrates only the endometrium, while placenta increta invades both the myometrium and endometrium.
What are the immediate risks of hemorrhage in placenta previa?
(A) Shock, maternal death, and increased risk of infection.
(B) Anemia
(C) IUGR
(D) Congenital anomalies
What medical management is required for placenta previa?
IV access, laboratory exams, blood typing and cross-matching, and administration of Betamethasone (Celestone).
What surgical interventions may be needed in placenta previa?
Amniocentesis and cesarean section.
What is the purpose of Betamethasone (Celestone) in placenta previa?
To accelerate fetal lung maturity in case of preterm birth.
This is known as the premature separation of the implanted placenta before the birth of the fetus.
Abruptio Placenta
The hemorrhage is abruptio placenta can either be what?
OCCULT OR APPARENT
Describe occult hemorrhage.
The placenta separates centrally and a large amount of blood is accumulated under the placenta.
Describe the apparent hemorrhage.
The present is along the placental margin; and the blood flows under the membranes through the cervix.
What causes bleeding when the placenta begins to detach during pregnancy?
Bleeding from placental vessels, which increases as a larger area detaches.
What should be assessed in a patient with abruptio placenta?
(A) Determine the amount and type of bleeding along with the presence and absence of pain
(B) Monitor maternal and fetal VS (Maternal bp, pulse, FHR, and FHR Variability)
(C) Palpate the abdomen: Note for the presence of contractions and relaxations and assess the abdomen for firmness
(D) Measure and record fundal height to evaluate concealed bleeding
(E) Prepare for possible delivery
What is a priority nursing intervention for ineffective placental tissue perfusion?
Position the patient in the left lateral position with the head elevated to enhance placental perfusion.
What are the different nursing interventions for ineffective placental tissue perfusion in abruptio placenta?
(A) Evaluate fetus status wit continuous fetal monitoring
(B) Evaluate the amount of bleeding by weighing all pads.
(C) Monitor CBC results and vital signs.
(D) Administer oxygen through a snug face mask at 8 to 12L per minute
(E) Prepare for possible CS delivery
What are the nursing interventions for acute pain related to increase uterine activity?
(A) Instruct or encourage breathing techniques to augment analgesics
(B) Instruct the patient on the cause of pain to decrease anxiety
(C) Administer pain medication as needed and as prescribed.
What is the priority nursing intervention for 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.
What are other nursing interventions for fluid volume deficit in abruptio placenta?
(A) Evaluate coagulation studies
(B) Monitor maternal vital signs and contractions
(C) Monitor vaginal bleeding and evaluate fundal height to detect and increase in bleeding.
What are the nursing interventions for risk for infection in abruptio placenta?
(A) Use aseptic technique when providing care
(B) Evaluate temperature every 4 hours unless elevated; then
evaluate every 2 hours.
(C) Evaluate WBC and differential count
(D) Teach perineal care and handwashing techniques
(E) Assess odor of all vaginal bleeding or lochia
What are possible complications of placental abruption? (MAPASRRMP)
(A) Maternal shock
(B) Anaphylactoid syndrome of pregnancy
(C) Postpartum hemorrhage
(D) Acute respiratory distress syndrome
(E) Sheehan’s syndrome
(F) Renal tubular necrosis
(G) Rapid labor and delivery
(H) Maternal and fetal dealth
(I) Prematurity
What are key medical treatments for placental abruption?
IV administration of fibrinogen or cryoprecipitate and laboratory examinations.
What is the primary surgical management for placental abruption?
Cesarean section (CS) delivery.
When does placenta previa typically occur?
In the third trimester, commonly at 32-36 weeks.
When does abruptio placentae usually occur?
In the third trimester.
What are the characteristics of bleeding in placenta previa?
Mostly external, small to profuse in amount, and bright red in color
What are the characteristics of bleeding in abruptio placentae?
May be concealed or external, with dark hemorrhage or bloody amniotic fluid.
How does the uterus feel in placenta previa?
Usually soft, with no pain.
How does the uterus feel in abruptio placentae?
Irritable, progressing to a board-like consistency, with pain usually present.
How is fetal heart tone affected in placenta previa?
Usually normal.
How is fetal heart tone affected in abruptio placentae?
May be irregular or absent.
What is the engagement status of the presenting part in placenta previa?
Usually not engaged
What is the engagement status of the presenting part in abruptio placentae?
May be engaged.
How severe is shock in placenta previa?
Usually not present unless bleeding is excessive.
How severe is shock in abruptio placentae?
Moderate to severe, depending on concealed and external hemorrhage.
How is delivery managed in placenta previa?
May be delayed depending on fetal size and bleeding amount
How is delivery managed in abruptio placentae?
Immediate delivery, usually via cesarean section.
