Important Facts About Placenta Previa

Placenta previa is the implantation of the placenta at least partially covering the
cervix, occurs in about one in 200 pregnancies. There are actually three types of
previa.
 Type I or low lying: The placenta encroaches the lower segment of the uterus but
does not infringe on the cervical os.
 Type II or marginal: The placenta touches, but does not cover, the top of the cervix.
 Type III or partial: The placenta partially covers the top of the cervix
 Type IV or complete: The placenta completely covers the top of the cervix.

Risk Factors

 Race is a controversial risk factor, with some studies finding that people from Asia
and Africa are at higher risk and others finding no difference.
 Women who are younger than 20 are at higher risk and women older than 30 are at
increasing risk as they get older.
 Previous placenta previa, caesarean delivery,or abortion.
 Women who have had previous pregnancies, especially a large number of closely
spaced pregnancies, are at higher risk.
 Women with large placentae from twins or erythroblastosis are at higher risk.
 Women who smoke or use cocaine may be at higher risk.
 Other reasons to suspect a previa would sometimes be premature contractions,
abnormal lie (breech, transverse, etc.), or the uterus measuring larger than you
should according to dates.
*Placenta praevia increases the risk of puerperal
sepsis and postpartum haemorrhage because the lower segment to which the
placenta was attached contracts less well post-delivery.

Complications

Risks for the baby include:

• Problems for the baby, secondary to acute blood loss
• Intrauterine growth restriction (IUGR) due to poor placental perfusion
• Increased incidence of congenital anomalies
Risks for the mother include:
• Life-threatening hemorrhage
• Cesarean delivery
• Increased risk of postpartum hemorrhage
• Increased risk placenta accreta (Placenta accreta is where the placenta attaches
directly to the uterine muscle.)

Predisposing factors

The following can increase your risk for placenta previa:

• Advanced maternal age

• Increased parity (number of pregnancies)
• Previous uterine surgery, including cesarean section (regardless of incision type)

Initial Intervention

1. An initial assessment to determine the status of the mother and fetus is

required. Although mothers used to be treated in the hospital from the first
bleeding episode until birth, it is now considered safe to treat placenta previa
on an outpatient basis if the fetus is at less than 30 weeks of gestation, and
neither the mother nor the fetus are in distress.

2. During second trimester ultrasounds, done in some places on a routine

basis, will show that there are many more previas diagnosed at this stage.

3. Placenta previa, once diagnosed, will usually mean bed rest for the
mother, frequently in the hospital. Depending on the gestational age steroid
shots may be given to help mature the baby's lungs. If the bleeding cannot
be controlled immediate cesarean delivery is usually done, regardless of the
length of the pregnancy. Some marginal previas can be delivered without
cesarean surgery, the other types of placenta previa preclude vaginal
delivery.
 Breastfeeding

Breastfeeding is the feeding of an infant or young child with breast milk directly
from female human breasts(i.e., via lactation) rather than from a baby bottle or other
container. Babies have a sucking reflex that enables them to suck and swallow milk.
Most mothers can breastfeed for six months or more, without the addition infant
formula or solid food.

Benefits of Breastfeeding
To the baby
• Provides good nutrition. Breastmilk is all the food and drink the baby needs from
birth up to 6 months of age. It has the essential nutrients to help the baby grow
and is easily digested and absorbed.
• Provides immunity and protection against illnesses especially when colostrum is
given. Colostrum is the thick, yellowish substance from the breast produced in
the first few days after birth. It contains antibodies that give immunity and
protection against infections, allergies and diseases, resulting to less frequent or
less severe infections.
To the mother
• Aids in the contraction of the uterus to normal size and prevents post-delivery
bleeding.
• Provides a natural contraceptive that helps in child spacing allowing the mother's
body to "recover" from the demands of pregnancy. It therefore, helps in ensuring
the good nutritional and health status of the mother.
• Lowers risk of breast and ovarian cancers.
• Does not add to the chores of the mother since there are no bottles to be washed
and sterilized, no milk formulas to prepare.
To the baby and mother
• Helps establish and strengthen emotional bond between baby and mother.
• Mother feels satisfied feeding the baby and baby feels secure.
To the family
• Saves money that would otherwise be spent for buying infant formula, feeding
bottles, and fuel.

To the community
• Helps in developing healthy children and adults who can contribute to socio-
economic development.
• Saves money that would have otherwise been used for sickly children.
 BREASTFEEDING POSITIONS
Getting comfortable

➢ Making sure that you’re comfortable and relaxed and that baby is correctly attached can help to
make breastfeeding easier and more enjoyable. Try to feed in a chair that offers good back
support; use cushions or pillows to prop up your arms; and if necessary, rest your feet on a
telephone book or footstool. It’s also good to experiment with the different feeding positions,
shown below, until you find one that works for you and baby.

Breastfeeding positions

➢ This is the classic 'front hold' or'cradle position'.

➢ The 'underarm position' shown above is also known as the 'footy hold'. It’s possible to feed
twins together in this position (see below).

➢ The 'lying down' position is particularly good for mums who’ve had caesareans or if your bottom
is sore after the birth.

Other positions

➢ In the first few weeks, it may be easier to feed twins separately. However, once you’ve got the
hang of it, you can try feeding them together using the 'twin hold'.

➢ If you feel uncomfortable or self-conscious when breastfeeding in public, drape a light muslin
wrap over your shoulder so it covers your breast and baby.
 Alternative Ways to Bathe Baby

As with everything there is always more than one way to do it! While the above
is the traditional way that many people use to bathe their babies, there are alternatives.
A great one to use is to actually bring the baby into the bath with you. This is
particularly good if the baby is very fussy or sick. They love the skin-to-skin contact.
You simply cradle the baby on your lap and bathe them. When you're done, you can
either hand the baby off to another adult and finish your bath or get out and take care of
baby. This is also a great technique for baby's who are having trouble latching onto the
breast. The water and skin contact can be enough to help them relax and nurse more
effectively.

1. Gather up your bathing supplies.

Being prepared is usually the first step with anything having to do with a baby!
So, gather a towel, wash cloth, any soaps or lotions you intend to use. Having it handy
prevents mishaps in the bath. It also helps you be more confident in the bathing
process. Be sure to place these items where you can easily reach them so that your
baby is never unattended.

2. The Bathroom Environment

It doesn't matter what form of tub you're using, whether it's the regular bath tub,
a baby bathtub or container, the water needs to be shallow and just the right
temperature, about 100 degrees Fahrenheit. Many people suggest testing the water
with your wrist, an area of more sensitive skin. You also want to ensure that whatever
room you are in is warm enough and free of drafts.
3. Strip Tease: Removing Baby's Clothes
Now it's time to undress your baby. Talk to your baby as you remove their
clothing. Hold them closely and make them feel secure. If you have a baby who
absolutely hates to be naked, try doing a sponge bath for the first few weeks, and
slowly undress them and wrap them in a towel, and only uncover the part you're
currently washing. Generally you can graduate to the regular tubs at a later stage.
4. Washing the Baby
Place the baby in the tub, but always hold on with one hand for safety. Use your
other hand, or any small helpers, to take the wash cloth and begin washing the baby.
Remember to start with the face and neck and do the diaper area last. Many soaps for
baby can be used in their hair. You also have the option of not using soap on baby's
delicate skin.
5. Finishing Up the Bath
Once baby is washed, wrap him or her in a towel and leave the bath stuff for a
clean up later. Use the towel to dry baby off. You can, if you desire, use lotion on the
baby after a bath, though it's not necessary for most babies. Put a clean diaper and
outfit on the baby. Once baby is sleeping or with someone else, you can then clean up
the bath equipment.
 As with everything there is always more than one way to do it! While the above
is the traditional way that many people use to bathe their babies, there are alternatives.
A great one to use is to actually bring the baby into the bath with you. This is
particularly good if the baby is very fussy or sick. They love the skin-to-skin contact.
You simply cradle the baby on your lap and bathe them. When you're done, you can
either hand the baby off to another adult and finish your bath or get out and take care of
baby. This is also a great technique for baby's who are having trouble latching onto the
breast. The water and skin contact can be enough to help them relax and nurse more
effectively.

Proper Ways of Changing Diaper

1. Gather Your Diapering Supplies
The first step is to be prepared. Gather up a couple of diapers, wipes,
ointments...anything you'd need to change the baby. For safety reasons you don't want
to be searching for something with a wiggly baby waiting for you. I also always open a
wipe or two and have it unfolded and laid out ready to use.

2. Lay the Baby Down

Most people have a specific area to change baby. This can be a changing table
or changing pad. If you have a table, be sure to use the strap for baby's safety. Never
leave baby unattended while changing him or her. Unfasten the old diaper, but don't
pull it out from under the baby yet. This allows for some margin of safety in case the
cold air inspires baby to let go.
3. Hold on to the baby
Grasp the baby's ankles and gently lift their bottom up and begin to wash their
bottom with the wipes. If the area is heavily soiled you can use the front part of the old
diaper to remove part of the mess. As you finish with each wipe, gently place in under
the baby (clean side up) for easier clean up. When the baby's skin is clean pull the
diaper and wipes out from under baby and set it aside.
4. Fresh and Clean Baby
Place the new, clean diaper under baby and secure the fasteners. If your still
have a newborn, you might need to fold down the top of the diaper to make room from
the umbilical cord.
5. Clean up!
After putting baby's clothes back on, take the old diaper and use the fasteners to
make it into a small ball, criss-crossing the fasteners. Place it in the diaper pail or trash.
I always keep a container of liquid disinfectant near my changing table to use on my
hands. Then I hand the baby off to someone else or lay her down and wash my hands
at the sink.
 Umbilical Cord Care

It is important to provide proper care for this portion of remaining cord at the baby's
navel until it heals and separates from the umbilicus - usually within two weeks after
birth. The stump will change from a yellow-green colour to black as it dries out. Be
aware that at this point it will not be possible to determine whether your child will have
Self-Care at Home
• During the first hour after delivery, usually following the baby's first bath, the
umbilical stump (as it is now called) is treated with an antiseptic applied directly onto
it, to decrease the chance for infection.

• Twenty-four hours after delivery, the clamp can be safely removed from the stump. It
is a good idea to make sure the clamp is removed at the hospital, before the baby
goes home. The clamp can get stuck during the home diaper changes and can pull
on and injure the stump.

• After mother and baby are discharged from the hospital or 24 hours after delivery,
your pediatrician may recommend wiping the stump and the surrounding skin area
with rubbing alcohol 2-3 times a day until the stump falls off. But some research
suggests that the stump may heal faster if left alone. It's important to follow your
physician's advice.

• Keep the stump dry, and expose the stump to air as much as possible to help dry out
the base. Keep the front of the diaper rolled out and down. Change wet or soiled
diapers quickly to prevent irritation. In warm weather, dress your baby in a diaper
and T-shirt to improve air circulation.

• Avoid bathing in a baby tub or sink until the stump falls off. Sponge baths are often
the best way to wash the infant until this happens.

• Within the first two weeks, the cord usually falls off. When this happens, you may
notice a small, pinkish area in the bottom of the belly button, which does not look like
the rest of the skin. This is expected, and normal skin will grow over it. Once this
happens, it is safe to give your baby a bath. Resist the temptation to pull off the
stump yourself, even if it's hanging on by only a thread.

• Remember, it's normal to see a little crusting or even dried blood near the stump.
References: http://www.wikipedia.com

http://www.emedicinehealth.com

http://www. pregnancy.about.com

http://www.nnc.da.gov.ph

http://www.abc.net.au