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Pt's History

Family History:

No family history of placenta previa, no history if DM, her mother was hypertensive. She have 2 children with heart problems.

In My Patient

Asymptomatic.

Pt's Demogphic Data

According to Text Book

Bright red vaginal bleeding without pain during the second half of pregnancy.

Contraction. (mayoclinic.org. 2014)

Past Medical and Surgical History:

Pharamacology

No surgical history, medical history: she was diagnosed with vitamin D deficiency 8 years ago.

Menstrual History:

clinical manifestation

Patient Initials: F.H. Age: 37 years old.

Address: Al-Suaaiq. Level of Education: Not educated

Occupation: Not working Nationality: Omani

Consanguinity : No Date of Admission: 28/9/2015

• Age of menarche: 15 years old.

• Cycle: Regular.

• Duration of menarche: 28 days.

• Interval of cycle: 6 days.

Etiology

Obstetric History:

Chief Complaints and Duration:

In My Patient

Increased parity.

Advanced maternal age

Gravida: 8 Para: 6 Abortions: 1 Fetal Death: 0 Died: 0 Alive: 6

L.M.P: 17/3/2015 EDD(Scan): 14/11/2015 EDD(history): 24/11/2015

According to Text Book:

Increased parity.

Advanced maternal age.

Past cesarean birth.

Past uterine curettage.

Multiple gestation.

Male fetus. (Adele Pillitteri,2010)

lab investigation

Patient was not complaining of pain, only she was referred from Bedayah HC after the USG showed that she have placenta previa

ASSESSMENT

Antenatal Assessment

Physical Examination:

Difficulty in breathing, no pale skin, good peripheral perfusion, no deep vein thrombosis, no enlargement of the lymph nodes, no edema in limbs, body is well dehydrated.

Management

NCP

In My Patient

Bed rest.

According to Text Book

• 90% of placenta previas in early pregnancy resolve in their own, so there is no need for early treatment unless there is complication.

• Lying on bed most of time, setting and standing only when necessary. (mayoclinic.org, 2014).

  • Cesarian section

Cesarian section

Impaired breathing pattern related to the mother is thinking of the worst scenario about her fetus.

Fear related to upcoming surgery and concerning about her baby.

Risk for fluid volume related to bleeding.

Conclusion

what is placenta previa?

A condition occurs when a baby's placenta partially or totally covers the opening in the mother's cervix

Evidence

SUMMARY OF EVIDENCE

This evidence is about early diagnosis of placenta previa to determine the management for it. The method that is used to diagnose it is Transvaginal ultrasound (TVS). This diagnostic test was done on my patient and the results showed that she have marginal placenta previa. This evidence mainly was about the use of TVS in correctly diagnosing placenta's location of implantation in order to determine the best management for the ladies. Also its about minimizing hospital admition and unnecessary intervention. The researcher went through the results of "Placenta Previa" in MEDLINE and bibliographic review. There were many options to check about like route of delivery (based on placenta edge to internal cervical os distance), In-patient versus out-patient, antenatal care, and cerclage to prevent bleeding.

Diagnosis and management of placenta previa.

Society of Obstetricians and Gynaecologists of Canada: 2010

The results were:

1. TVS is better than transabdominal sonography in detecting the placenta's location.

2. Sonographers should report the actual distance between placental edge to the internal cervical os in millimeters.

3. Ultrasound should be repeated regularly depending on the gestational age, distance from the internal os, and clinical features such as bleeding, because placenta can change its location.

4. When the placenta is implemented more than 20mm away from the internal cervical os, the lady can deliver vaginally with a high expectation os success.

5. When the placenta is implemented from 20mm to 0mm, the lady will go into cesarean section.

The real practice differs with this literature in few things. Among of them is the distance. Actually it's not measured in mm, only they're describing its location.

As for my learning experience, I totally learned a new thing from this evidence. We usually concentrate on the nursing intervention and their evidences but knowing how a diagnostic test is helping was a first for me.

The placenta provides oxygen and nutrients to the growing baby and removes waste products from the baby's blood. It attaches to the wall of the uterus, and the baby's umbilical cord arises from it. In most pregnancies, the placenta attaches at the top or side of the uterus. In placenta previa, the placenta attaches to the lower area of the uterus.

Pathophysiology

The placenta provides oxygen and nutrients to the growing baby and removes waste products from baby's blood. It attaches to the wall of the uterus, and the baby's umbilical cord arises from it. In most pregnancies, the placenta attaches at the top or side of the uterus. In placenta previa, the placenta attaches to the lower area of the uterus.

OBJECTIVE: To review the use of transvaginal ultrasound for the diagnosis of placenta previa and recommend management based on accurate placental localization.

OPTIONS: Transvaginal sonography (TVS) versus transabdominal sonography for the diagnosis of placenta previa; route of delivery, based on placenta edge to internal cervical os distance; in-patient versus out-patient antenatal care; cerclage to prevent bleeding; regional versus general anaesthesia; prenatal diagnosis of placenta accreta.

OUTCOME: Proven clinical benefit in the use of TVS for diagnosing and planning management of placenta previa.

EVIDENCE: MEDLINE search for "placenta previa" and bibliographic review.

BENEFITS, HARMS,AND COSTS: Accurate diagnosis of placenta previa may reduce hospital stays and unnecessary interventions.

Placental implementation initiated by the embryo (embryonic plate)

The embryo adhering in the lower uterus

Health education

With the placental attachment and growth, the developing placenta may cover the cervical os.

Health education points

Rationale

To decrease her level of fear and anxiety

Instruct the patient to prepare herself mentally for the cesarean section.

References

To prevent heavy bleeding and its complications.

Advice the patient to take care of herself and not work hard and handle heavy things.

1. Interview with patient.

2. Pillitteri.A, 2014, Maternal and child health nursing, Walters Kluwer, London, P: 564 CH: 21.

3. Amy M. Karch, (2015), Nursing drug guide, New York, P: 162-165, 216-218, 976-978.

4. By Mayo Clinic Staff (2014), placenta previa, from website http://mayoclinic.org

5. Journal of Obstetrics and Gynaecology Canada, September 20,2010, from website: http://europepmc.org/abstract/med/17346497

To decrease her anxiety about the cesarean section.

Instruct the patient not to listen to other ladies about the cesarean section.

Content:

Patient's Demographic data

Patient's History

What is placenta previa?

Pathophysiology

Etiology

Clinical manifestation

Lab investigation

Pharmacology

Management

NCP

Evidence

Health education

Conclusion

References

Placenta Previa: Case Study

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