PLACENTA PREVIA

• What trimester does placenta previa occur?

  3rd trimester
• PLACENTA PREVIA

  • Improperly abnormal implantation of the placenta in the lower uterus
  • Spotting during the 1st and 2nd trimester
  • Bleeding is sudden, profuse
  • Bleeding may not occur until onset of cervical dilatation causing the placenta to loosened from the uterus
• PATHOPHYSIOLOGY

  The embryo adhering in the lower uterus or abnormal implantation of the placenta. May develop and cover the cervical os = lead to MATERNAL DEATH and FETAL DEATH.
• SIGNS AND SYMPTOMS

  • Painless vaginal bleeding: the bleeding may be mild to profuse, and the blood color is usually bright red
  • Released uterus: Soft and non-tender uterus
• PREDISPOSING FACTORS

  • Multiparity
  • Advanced maternal age
  • Previous cesarean births
  • Uterine incisions
  • History of placenta previa
• RISK FACTORS

  • Trauma or injury to your uterus (like a car accident, fall or blow to the stomach)
  • Previous placental abruptio
  • Multiple gestations (twins or triplets)
  • High blood pressure (hypertension), gestational diabetes or preeclampsia
  • If you smoke or have a history of drug use. (CONSIDER TERATOGEN SUBSTANCES)
  • Short umbilical cord
  • Uterine fibroids
  • Thrombophilia (a blood clotting disorder). DIC
  • Premature rupture of membranes (the water breaks before the fetus is full term).
  • Rapid loss of the amniotic fluid
• TYPES OF PLACENTA PREVIA

  1. TOTAL/ COMPLETE – placenta covers the entire maternal/ cervical os
  2. PARTIAL – small part of placenta covers the internal cervical os
  3. MARGINAL – covers only part of the internal os. Cover the edge. Within 2-3 cm of the LOWER BORDER of the cervix.
  4. LOW-LYING – implanted low in the uterus but do not cover the internal os

  Concealed placental abruption have little or no visible vaginal bleeding. Blood is trapped between the placenta and uterine wall
• GRADES OF PLACENTA PREVIA

  • GRADE 1: small amount of bleeding, some uterine contractions, and no signs of stress to THE MOTEHR of the fetus
  • GRADE 2: Mild to moderate amount of bleeding, some uterine contractions, and signs of fetal stress.
  • GRADE 3: Moderate to severe bleeding or concealed bleeding, uterine contraction that do not relax, abdominal pain, low blood pressure, and fetal death.
• NURSING MANAGEMENT

  Watchful waiting: expectant management

  • That the mother is not in labor that would cause preterm labor and delivery
  • Fetus is premature but must be stable and not in distress
  • Take note for bleeding monitor and note signs of blood loss
  • No internal examination

  Watch out for complications such as:

  -        Hemorrhage

  -        Prematurity labor and delivery

  -        Obstruction of birth canal – concealed blood
• NURSING MANAGEMENT

  • Maintain bedrest – left lateral recumbent
  • Careful assessment: vital signs/ onset of progress of labor and FHT
  • Prepare for ultrasound to detect site of PLACENTA
  • Provide psychological and physical comfort
  • Immediate or emergency os
  • Vital signs and fetal monitoring
  • Observe for signs of shock, rapid pulse rate, pallor, cold clammy skin, sudden drop of blood pressure
  • Enforce strict bed rest
  • Observe and refer additional bleeding episodes
• Pain in abruptio placenta

  Painful vaginal bleeding – sharp stabbing pain that radiates to the back
• Pain in placenta previa

  Painless vaginal bleeding
• Color of blood in abruptio placenta

  Dark red
• Color of blood in placenta previa

  bright red
• Abdomen in abruptio placenta

  Rigid/hard/boardlike abdomen - Couvelaire sign
• Abdomen on placenta previa

  Soft/related