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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.
According to Text Book
Bright red vaginal bleeding without pain during the second half of pregnancy.
Contraction. (mayoclinic.org. 2014)
No surgical history, medical history: she was diagnosed with vitamin D deficiency 8 years ago.
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.
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)
Patient was not complaining of pain, only she was referred from Bedayah HC after the USG showed that she have placenta previa
Cesarian section
A condition occurs when a baby's placenta partially or totally covers the opening in the mother's cervix
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.
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.
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