Placenta previa, Abruptio placentae Flashcards
placenta is implanted in the lower uterine segment
instead of in the upper posterior
Placenta Previa
how much the internal cervical os is covered
placenta previa classification
OS is completely covered
-always c-section
complete or total
part of os covered
-always c-section
partial
edge of placenta close to os
-may be able to deliver
marginal
not true placenta previa. Placenta not near os but
implanted in lower uterine segment.
• Usually does not cause complications. May have spotting.
low lying placenta previa
- Advance maternal age (>35 years)
- Previous cesarean birth
- Multiparity
- Short interval between pregnancies
- Uterine injury
- History of uterine surgery
Risk factors for placenta previa
•Usually diagnoses by ultrasound
•Bright Red, painless bleedingduring 3rd trimester
•1st bleeding episode around 29-30 weeks
-rarely life-threatening
•Increased risk of hemorrhage during labor as cervix dilates and effaces tearing placenta
•Fetus may be in abnormal position
Placenta previa S/S
- Pre-term–bedrest until fetus mature to decrease pressure on placenta and cervix
- Marginal and low-lying may deliver vaginally unless bleeding is extensive
- C-section for partial or total to prevent extensive hemorrhage
Placenta previa medical management
- NO vaginal exams (until you know where placenta is at via ultrasound–tears placenta
- If laboring, monitor blood loss, S/S of hypovolemic shock
- Monitor VS
- Monitor FHR–NST, US, biophysical profile
- Prep for C-section as necessary
- Emotional support and teaching
Placenta previa nursing care
-Monitor postpartum for hemorrhage and infection
-Labs
•CBC
•type and Rh, type and crossmatch
•coagulation profile
•Hgb and Hct
Placenta previa nursing care (2)
detachment of part or all of the placenta from its implantation site
•Separation occurs in the decidua basalis after 20 weeks gestation
•Accounts for 15% of perinatal deaths
-50% from prematurity
-intrauterine hypoxia
abruption placenta
occurs in center with edges still intact. Usually no visible bleeding.
central - abruption placentae
separation along an edge with or without vaginal bleeding
- detaching from uterine wall, not much blood since it is filling up amneotic sac
- dark red blood
marginal - abruption placentae
total separation. Fetal and maternal compromise. Emergency c-section.
- no perfusion to baby
- mom could bleed out
complete - abruption placentae
- Dark Red Bleeding
- sudden onset of intense, localized uterine pain
- uterus tender, firmness that becomes rigid
- crampy contractions that don’t relax - lose resting tones
- fetal distress may be present due to compromised circulation
abruption placentae S/S
-Dependent on maternal and fetal status
-C-section if:
•fetal distress
•severe hemorrhage
•poor labor progress
•increasing uterine resting tone
•coagulopathy
Abruptio placentae medical management
Vaginal birth if: •mother’s hemodynamics are stable •live fetus without distress •intrauterine death Fluid replacement with whole blood and LR •maintain output 30-60ml/hr •maintain Hct of 30%
Abruptio placentae medical management (2)
- Hypertension
- History of prior abruptio placentae
- Smoking
- Cocaine Use
- Trauma
- Prior uterine surgery
- Rupture longer than 24 hours
- Over distention of the uterus
risk factors of abruption placentae
-Assess bleeding–amount, color
-Abdominal assessment
•Previa–soft, relaxed, nontender
•Abruptio–tenderness, pain, firm or rigid
-Labs
•CBC
•type and Rh, type and crossmatch
•coagulation profile
abruption placentae
- Vital signs, cardiac output monitored
- FHR monitoring–decelerations, changes in baseline
- Uterine activity monitored
- Client and family teaching, emotional support
- Prep for c-section as necessary
aburptio placentae nursing care
