PLACENTAL PROBLEMS Flashcards
- An implantation of the placenta in the lower uterine segment.
- Cause is unknown but is thought to occur whenever the placenta is forced to spread to find an adequate exchange surface.
placenta previa
risk factors of placenta previa
- hx of previa
- multiparity
- increasing age
- large placenta
- smoking and cocaine use
- previous CS
- uterine surgery
- abortion
- multiple gestation
- male fetus
Placenta completely covers the internal cervical OS
total placenta previa
Placenta partly covers the cervical opening but does not completely cover the OS.
partial placenta previa
Placenta edge reaches within 2 to 3 cm of the cervical opening
marginal placenta previa
Placenta is implanted in the lower uterine segment near the cervix but does not cover the internal cervical OS
low lying placenta previa
s/sx of previa
- painless uterine
- bright red bleeding
- soft, relaxed nontender uterus
- fundal height > age
- unengaged presenting part
done to see the location and position of placenta
transabdominal ultrasound
if the mother is stable & the fetus is immature and has reassuring status = ??
delay birth, administer betamethasone, observe bed rest
Ultrasonographic examination may be done every ___ weeks
2-3 weeks
Fetal surveillance – ___ and ___ once or twice a week
NST and BPP
true or false - you can do vaginal or
rectal examinations during previa
false
if woman is at term = ??
CS delivery is almost always indicated
true or false - In women who have minimal bleeding, vaginal birth may be attempted
true
complications of previa
- prom
- hemorrhage
- preterm labor
- premature separation of a normally implanted placenta from the uterine wall before the fetus is born
- Occurs in cases of bleeding and formation of hematoma(clot) on maternal side of the placenta
abruptio placenta
risk factors of abruptio
- cocaine
- HTN
- smoking
- multigravida
- hydramnios
- increased maternal age
- abd trauma
- PPROM
- chorioamnionitis
- alcohol
- domestic violence
- short cord
- thrombophilia
bleeding formation of hematoma > ___ of hematoma > ____ of placenta
expansion; separation
abruptio: Major dangers for the woman:
hemorrhage, hypovolemic shock, clotting abnormalities
abruptio: Major dangers for the fetus:
asphyxia, blood loss, prematurity
when the placenta doesn’t completely detach from the uterine wall
partial abruptio placenta
when the placenta completely detaches from the uterine wall
complete abruptio placenta
when the placenta detaches from the uterine wall, starting from its central portion
central abruption placenta
- Uterus turns entirely blue because the muscle fibers are filled with blood
- Uterus contracts poorly after birth
- Necessitates hysterectomy
couvelaire uterus
s/sx of couvelaire uterus
- dark red bleeding
- rigid uterus
- sharp, stabbing pain in the fundus
- low intensity contractions
- abd or low back pain
goal in abruptio placenta
pt will exhibit signs of increased blood volume and restoration of cardiac output
early signs of hypovolemic shock
- fetal and maternal tachycardia
- decreased BP
- increased RR
- cool, pale skin and mucous membranes
late signs of abruptio
- falling BP
- pallor, cold and clammy
- UO < 30 ml/hr
- restlessness, agitation
how to promote tissue oxygenation
- o2 support
- lateral position
- head FOB
- limit activity
a serious pregnancy condition that occurs when blood vessels & other parts of the placenta grow too deeply into the uterine wall
placenta accreta
placenta adhered to myometrium with no intervening decidua
placenta accreta
placenta is within the myometrium
placenta increta
placental tissue is extrauterine or on the uterine serosa
placenta perceta
causes of accreta
- abnormalities in the uterus lining
- hx of CS delivery
risk factors of accreta
- previous uterine surgery
- placenta position
- maternal age
- previous childbirth
- uterine conditions
- presence of tumor
s/sx of accreta
- vaginal bleeding during the 3rd trimester (27-40 wks)
- massive bleeding during labor and delivery
imaging test for accreta
ultrasound and MRI
blood test for accreta
alpha-fetoprotein
management for accreta
- placenta is left in the uterus
- cord ligated
- closure of the uterus
- methotrexate
- prophylactic antibiotic
surgical management for accreta
cesarean, hysterectomy
in a ___ hysterectomy, hormones decrease because the ovaries are removed, which results in ___
radical; hot flashes
for clients taking methotrexate, instruct to?
increase OFI to at least 2L per day
complications of accreta
- uterine rupture
- heavy vaginal bleeding
- premature birth
- disseminated intravascular coagulation
true or false - placenta accreta can be prevented by avoiding the risk factors
false - there is no way to prevent placenta accreta
