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Placental Abruption/ Placental Previa

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Megan Frank

on 19 December 2011

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Transcript of Placental Abruption/ Placental Previa

Placenta Previa
&
Placental Abruption Megan Frank, Katie Geraghty, Vanessa Williams Placenta Previa occurs when the placenta is attached to the lower
part of the uterus instead of the upper part
4 TYPES Complete- os of cervix is totally covered
Partial- os of cervix partially covered
Marginal- Edge of placenta covered
Low-lying- close to os of cervix, but does not fully cover it ETIOLOGY Unknown
4/1000 births
Risks
-Minorities
-Previous c/s
-High gravidity or parity
-Older age
-Smoking
-Male fetus
-Previous induced or spontaneous abortion Signs & Symptoms #1 = BLEEDING!
The attachment to the lower section of the uterus poses a problem later in pregnancy when dilation and contraction take place
Due to the movement of the uterine wall, the placenta cant hold on anymore and becomes detached, causing the bleeding
There may also be some abdominal cramping, but usually pain is not experienced
confirmed via ultrasound So what does this mean? Because it is detected via ultrasound, most cases are aware of the condition before presenting with bleeding
-This allows for precautions to be taken such as more
frequent and careful monitoring
Best way to avoid complications of hemorrhage, shock, or death… CALL DOCTOR/ 911 IF BLEEDING OCCURS
-This will allow for safe delivery and treatment TREATMENT GOAL= safe delivery, term delivery Deliveries usually c/s Sometimes the placenta will move, but not tear, before dilation and contractions begin
-Bed rest/ Limit activity
-Pelvic rest
NO tampons, intercourse...Nothing should go into the vagina Also want to try and delay delivery until 37wks
Expectant management -Bed rest
-Pelvic rest
-Monitor blood loss, transfusion may be needed
-FHR
-VS
-Blood counts of mom and baby (after delivery)
-IV fluids Nursing Care Provide emotional support, this can be a
scary thing especially if bleeding
Allow time for questions
Explain procedures and progress
Physical support, especially during a
bleeding episode
Assess amount, color, pain, contractions, FHR, VS
When baby is born
Blood counts
May need O2, transfusion, NICU care Placenta Previa Review PLACENTAL ABRUPTION AKA: Abruptio Placentae DEFINITION when the placenta prematurely separates
from the uterine wall.
Hemorrhage usually follows:
external hemorrhage through the cervix
or a concealed hemorrhage,
when the blood pools
behind the placenta ETIOLOGY Occurs after 20 weeks of gestation
Usually occurs during labor
Occurs between 1 in 86 pregnancies to 1/206 pregnancies
Risk Fractors
-Abdominal trauma
-hypertension
-maternal age >35 years old
-short umbilical cord
-alcohol use
-drug use
-smoking
-multiparity
-uterine malformation
-previous c-sections
-large amount of amniotic fluid Severity of Placental Abruption Partial separation- usually characterized by internal bleeding between the placenta and uterine wall

Complete separation- massive bleeding LOCATIONS Marginal – separation is at the out edges of the placenta – considered mild- blood will pass vaginally

Central- separation in the center of the placenta- traps blood between the placenta and uterine wall- vaginal bleeding may not happen Classification 1. Mild: 10-20% of placenta is detached. Will have uterine pain, and bleeding. Mom and baby will remain stable

2. Moderate: 20-50% of placenta is detached. Will have pain and bleeding. Mom can remain stable but baby is in distress

3. Severe: More than 50% of placenta is detached. Possibility of baby and mother death Signs & Symptoms Vaginal bleeding
Contractions
Abdominal and back pain
Shock
Increased heart rate
Moist cool skin
Weakness
Increased thirst
Blood in amniotic fluid
Decreased fetal movement or heart rate ASSESSEMENT Pelvic exam
Ultrasound
-Shows a blood clot or depressed area in placenta
Monitor fetal heart rate and stress testing Treatment Mild cases:
bed rest and monitoring, if it’s time to deliver: vaginal delivery

Severe cases:
delivery: usually C-section

Assess and treat pain
Frequently monitor vital signs, intake and output, bleeding
NICU should be present to assess and treat the baby for blood loss, hypoxia, and shock FETUS Mother Education Distress and death may occur in cases with a lot of blood loss and low fetal gestational age.

Mortality rate: 20-30% mild- moderate, 100% if most or all of placental is detached:

Hypoxia, anemia, growth retardation, brain damage,
central nervous system anomalies Prognosis is good if hemorrhaging can be controlled
Mortality rate: 1%
Potential complications: post partum hemorrhage, shock, uterine rupture, necrosis of distal organs, renal failure, death Provide written information when teaching a patient about PA

Educate patient on risk factors

Educate patient if symptoms occur to immediately go to the ER PLACENTAL ABRUPTION REVIEW SOURCES Bergakker, S.A., (2010). Case report: management of elective cesarean delivery in the presence of placenta previa and placenta accreta. AANA Journal, 78(5), Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?hid=107&sid=db54bb5a-8d93-4b2a-a254-651809e34bc2%40sessionmgr112&vid=7

Gina Hoyt RN, C. C. (2006). Bleeding in pregnancy: Whats the diagnosis? . ED Insider , 16-18.

London, M.L., Ladewig, P.W., Ball, J.W., Bindler, R.C., Cowen, K.J., Maternal & Child Nursing Care. (2011). Upper Saddle River, NJ: Pearson Education Inc

Penn Medicine. (2005, January 14). Retrieved February 10, 2011, from Placental Abruption:http://www.pennmedicine.org/health_info/pregnancy/000127.htm

Placental Abruption: Abruptio Placentae. (2006, November). Retrieved February 10, 2011, from American Pregnancy Association: http://www.americanpregnancy.org/pregnancycomplications/placentalabruption.html

Placenta Previa. (2009, September 12). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001902 Placenta Previa vs. Abruptio Placentae PLACENTA PREVIA ABRUPTIO PLACENTAE

ONSET Quiet and sneaky Sudden and stormy
BLEEDING External External or concealed
COLOR OF BLOOD Bright red Dark venous
ANEMIA = to blood loss Greater than apparent blood loss
SHOCK = to blood loss Greater than apparent blood loss
TOXEMIA Absent May be present
PAIN Only labor Severe and steady
UTERINE TENDERNESS Absent Present
UTERINE TONE Soft and relaxed Firm to stony hard
UTERINE CONTOUR Normal May enlarge and change shape
FETAL HEART TONES Usually present Present or absent
ENGAGEMENT Absent May be present
PRESENTATION May be abnormal No relationship
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