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Abruption Placenta & Placenta Previa (1).pptx

The placenta provides oxygen and nutrients to the growing baby and removes waste from the baby's blood. Placental abruption occurs when the placenta separates from the uterus before delivery, which can decrease the baby's oxygen and cause heavy bleeding in the mother. Placenta previa is when the placenta blocks the cervix, which can cause severe bleeding during pregnancy and childbirth. Both conditions require close monitoring and may necessitate early delivery to prevent complications for the mother and baby.

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Definition :  Placenta: The placenta is an organ that develops in uterus during pregnancy. This structure provides oxygen and nutrients to growing baby and removes waste products from baby's blood. The placenta attaches to the wall of uterus, and baby's umbilical cord arises from it. The organ is usually attached to the top, side, front or back of the uterus.
Abruption Placenta & Placenta Previa *Prepared By Shima maaitah *Miss : Ghadeer Zayadeen
Objective *At the end of this seminar we will able to Identify : - Definetion - Pathophysiology . - Classification. - Causes , risk factors and complication -Signs and symptoms . - Laboratory and Diagnostic Testing -Nursing Assessment and Nursing medical management . - Pt education .
Abruption Placenta
 Abruption Placenta Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. This can decrease or block the baby's supply of oxygen and nutrients and cause heavy dark bleeding in the mother. It can occur at any time after 20 weeks of pregnancy, but it’s most common in the third trimester.
 the abruption start with degenerative change in the small maternal arterioles , resulting in : thrombosis ,, and possible rupture of a vessels .  Bleeding from the vessels forms a retroplacental clot . The bleeding causes increase pressure behind the placenta and result in separation . Pathophysiology
• Mild (grade 1): minimal bleeding (less than 500 mL), marginal separation (10% to 20%), tender uterus, no coagulopathy, no signs of shock, no fetal distress • Moderate (grade 2): moderate bleeding (1,000 to 1,500 mL), moderate separation (20% to 50%), continuous abdominal pain, mild shock, normal maternal blood pressure , maternal tachycardia . • Severe (grade 3):absent to moderate bleeding (more than 1,500 ml), sever separetion(more than 50%), profound shock , dark vaginal bleeding , sever abdominal pain , decreased maternal blood pressure tachycardia and development of dissminated intervascular coagulopathy (DIC). Abruptio placentae is classified to the : 1. extent of separation 2. the amount of blood loss from maternal circulation includs :
Abruptio placentae also may be classified as partial or complete , depending on the degree of separation.
Causes *The cause of placental abruption is often unknown. *Possible causes include : trauma or injury to the abdomen or HTN or smoking
Risk factors  maternal smoking  maternal age (over 35 years old ).  poor nutrition.  multiple gestation  sever trauma ( auto accident )  cocaine use  alcohol ingestion  preeclampsia
Vaginal bleeding Abdominal pain Uterine tenderness Back pain Fetal distress Signs and symptoms Rapid contraction
 maternal :  - sever hemorrage  - need for blood transfusion  - emergency hysterectomy  Complication
 Fetal :  - low birth weigh .  - preterm delivery .  -Decreased oxygen to the baby, which could lead to brain damage  - stillbirth . Complication
 Medical history  Physical examination, including checking the tenderness and tone of the uterus  CBC  Fibrinogen levels—typically are increased in pregnancy  (PT) , (PTT)  ultrasound  CT scan is more reliable method for evaluation of placenta abruption . Laboratory and diagnostic testing :
Begin the health history by assessing the woman for risk factors that may predispose her to abruption placenta . Assessing the pregnant woman presenting with abdominal pain The vaginal area is inspected for the presence of bleeding. Nursing Assessment
palpation of the uterus for tenderness, consistency, and frequency and duration of uterine contractions auscultation of fetal heart sounds and ask about fetal movement, recent changes in activity patterns .
Nursing Management  Obtain maternal vital signs frequently ,even 15 min .  Monitor the amount and characteristics of any vaginal bleeding as frequently as every 15 to 30 minutes.  Communicate empathy and understanding of the client’s experience, and provide emotional support.
Medical management  To avoid a worsening condition, these medical procedures are implemented for both the mother and the fetus :  1- Intravenous therapy : Once the woman starts to bleed, the physician would order a large gauge catheter to replace the fluid losses.  2- Oxygen inhalation: Delivered via face mask, this would prevent fetal anoxia.  3- Fibrinogen determination: This test would be taken several times before birth to detect DIC.
 If you’re less than 34 weeks pregnant: You might have be admitted into the hospital for monitoring -- as long as baby’s heart rate is normal and the placental abruption doesn’t seem to be severe. If baby appears to be doing fine and stop bleeding in mother , you eventually might be able to go home. You might also be given steroids to help baby’s lungs develop faster in case you do go into labor early.  If you’re more than 34 weeks pregnant: if the abruption does seem severe. If it is, and it’s putting health or baby’s health at risk, you’ll need a C-section right away. You might also need a blood transfusion. 
Health education *urge her to seek early and continuose prenatal care and receive promot health care if any signs and symptoms occure in future pregnancies . *encourage the women to avoid smoking ,or using drugs during pregnancy.
Nursing care plane planning Evaluation Rationale Nursing Interventions Nursing Diagnosis Goal : client will be relief or control of pain . Outcome : Patient will report relief or control of pain. . - The patient will be able to feel comfortable and verrbalize reduce of pain . To help determine the possibility of underlying condition or organ dysfunction requiring treatment. To maintain an acceptable level of pain. To promote non pharmacologi cal pain management. -Assess for referred pain as appropriate. -Administer analgesics as indicated. -Provide comfort measures, quiet environment, and calm activities. Acute Pain RT Sudden separation of placenta AMB Sharp, stabbing pain high in the uterine fundus Uterine tenderness
Placenta Previa
Definition : Placenta Previa :  when a pregnant woman's placenta blocks the opening to the cervix that allows the baby to be born. It can cause severe bleeding(Bright red) during pregnancy and delivery  . Partial previa: The placenta covers part of the cervical opening.  Complete previa: The placenta covers the entire cervical opening.
Type of placenta previa  Marginal: The placenta is next to the cervix but does not cover the opening.  . Partial previa: The placenta covers part of the cervical opening.  Complete previa: The placenta covers the entire cervical opening.
* The exact cause of placenta previa is unknown • It is initiated by implantation of the embryo in the lowor uterus may be due to : * damage in the upper segment • Uterine endometrial scarring • Which may incite placental growth in the unscarred lower uterine segment ,with placenta attachment and growth ,the cervical become coverd by developing placenta Pathophysiology
Risk factors  Maternal age ( more than 35 years ) .  Smoking .  Previous C/S birth .  Uterine injury .  Multiple gestations .  Previous induced surgical abortion .
Signs and symptoms  Vaginal bleeding without pain  . Contraction along with the bleeding
Complication  maternal :  bleeding after delivery .  Emergency caesarean delivery  Shock from loss of blood  Fetal :  Fetal distress from lack of oxygen
 CBC  Ultrasound Laboratory and diagnostic testing :
Nursing Assessment Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality. Monitor vital signs Monitor fetal HR Blood transfusion for the mother.
Medical management  Depends on :  the exent of bleeding : If it's light, your doctor might suggest you avoid activities including exercise. If it's heavy, you may need to go to the emergency room.  Whether the placenta previa is complete or partial  The exact location of the placenta  The gestational age of the baby  The position of the baby  The health of the baby
* Rest at home * Discharge plan * CTG ( fetal HR ) Contraction * dexamethazone If the amount of bleeding is small : If the amount of bleeding is large : Management : Blood transfusion for the mother. Delivary C/S
Health education  Encourage the women to avoid smoking ,or using drugs during pregnancy.  Do not do any heavy activity .
Nursing Diagnosis Nursing Interventions Rationale Deficient fluid volume related to active blood loss secondary to placenta previa *Monitor Vital Signs *Assess color, odor, consistency and amount of vaginal bleeding *Assess hourly intake and output. *To obtain baseline data *To assess degree of blood loss Provides information about maternal and fetal physiologic compensation to blood loss Outcome : The patient will re- establish a functional body fluid volume and balanced input and output status .
summary
Placenta abruption Placenta previa manifestation Sudden insdious Onset Can be concealed or visible Always visible ,slight, then more profuse Type of bleeding dark Bright red Blood description Constant, uterine tenderness on palpation None (painless) Discomfort / pain Firm to rigid Soft and relaxed Uterine tone Fetal distress or absent Usually in normal rang Fetal heart rate