Armi P.

Alina Group 1

Mrs. Ivy Maryll Avila RN, MSN Clinical Instructor

Placenta Previa is a complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the opening to the cervix. Different forms of Placenta previa Marginal: The placenta is against the cervix but does not cover the opening. Partial: The placenta covers part of the cervical opening. Complete: The placenta completely covers the cervical opening.

Causes: Women who smoke or have their children at an older age may also have an increased risk. Abnormal formation of the placenta Abnormal uterus Large placenta Scarred lining of the uterus (endometrium)

Incidence: Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have: o Abnormally developed uterus o Many previous pregnancies o Multiple pregnancy (twins, triplets, etc.)

o Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine surgery, or abortions Complications for the baby include:

Problems for the baby, secondary to acute blood loss Intrauterine growth retardation due to poor placental perfusion Increased incidence of congenital anomalies

Complications for the mother include:

Death Major bleeding (hemorrhage) Shock

*There is also an increased risk for infection, blood clots, and necessary blood transfusions Anatomy of the uterine/placental compartment at the time of birth: The cotyledons of the maternal surface of the placenta extend into the decidua basalis, which forms a natural cleavage plane between the placenta and the uterine wall. There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the branches of the uterine arteries that run through the wall of the uterus to the placental area. The placental site is usually located on either the anterior or the posterior uterine wall. The amniotic membranes are adhered to the inner wall of the uterus except where the placenta is located Diagnostic Evaluation: Placenta previa is diagnosed using transabdominal ultrasound. - transabdominal scans with fewer false positive results Transvaginal ultrasound If a woman is bleeding she is usually placed in the labor and birth unit or for cesarean birth because profound hemorrhage can occur during the examination. This type of vaginalexamination knows as the double- setup procedure

Ultrasonographic scan

If ultrasonographic scanning reveals a normally implanted placenta, an examination may be performed to rule out local causes of bleeding and a coagulation profile is obtained to rule out other causes of bleeding management of placenta previa depends of the gestational age and condition of the fetus and the amount and cesarean birth.

Complete blood count (CBC) To monitor mothers blood volume Fetoscope To monitor fetal heart rate and conditions

Clinical Manifestations: 1. Bleeding that is painless, sudden and profuse during the end of second trimester, or during third trimester. 2. Soft, nontender abdomen; relaxes between contractions, if present. 3. FHR stable and within normal limits. 4. Normal uterine tone 5. Leopolds maneuver: the fetus is in breech, oblique or transverse position. Treatment depends on various factors: How much bleeding you had Whether the baby is developed enough to survive outside the uterus How much of the placenta is covering the cervix The position of the baby The number of previous births you have had Whether you are in labor Nursing Management: Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh saturated perineal pads to assess maternal blood loss. Maintain bedrest and elevate the head of the bed. Provide fluid administration, usually with lactated Ringers solution, through a large-bore IV line to maintain fluid balance

 Consider cesarean delivery if the placenta previa is more than 30% or if excessive bleeding occurs. Measure fundal height to assess for rising fundus, which may reveal concealed bleeding. Disallow rectal or vaginal examinations, to minimize the danger of bleeding. Prepare the patient and family emotionally and physically for delivery. Observe for meconium in the amniotic fluid; may indicate fetal distress. Provide emotional support to the patient and family. Discharge Plan: Medication

Betamethasone (Celestone) is a corticosteroid that acts as an anti-inflammatory and immunosuppressive agent. Assess for contraindications of Betamethasone administration. Obtain reports of urine and cervical cultures and fibronectin.

Exercise

Needs to adequate her time with her child to be certain he or she is all right, and nurse can states hearing fetal heart beat helps to reassure her about babys health. Attach contraction and fetal heart rate monitoring for continuous evaluation of contractions of fetal response . Treatment Used of drugs Catheterization Health Teaching Maintain a bed rest Maintain a 8 glasses of water Ongoing Assessment Assess clients home surrounding to determine whether they are appropriate for bed rest and continuing monitoring at home. Administer oral dose and home monitoring requires professional supervision. Diet She might to begin to neglect her diet or her supplementary vitamins because It doesnt matter anymore

Spiritual Assess anxiety level of client over preterm labor possible feelings. Determine whether client wants a support person to be wit her, to the presence of a support person can offer additional comfort to a client. Possible Nursing Diagnosis for Placenta Previa:

Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental Implantation Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to Potential for Hemorrhage Altered Diversional Activity r/t Inability to Engage in Usual Activities Secondary to Enforced Bed Rest and Inactivity During Pregnancy