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Placenta previa

Placenta previa

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Placenta previa

  1. 1. PLACENTA PRAEVIA Presented by: Prabhjot Kaur M.Sc.(N) 1st Year CON, Adesh University
  2. 2. DEFINITION • The placenta is implanted partially or completely over the lower uterine segment (over or adjacent to the internal os ) it is called Placenta Praevia. D.C.Dutta
  3. 3. DEFINITION • In Placenta Praevia the placenta is implanted in the lower uterine segment such that is completely or partially cover the cervix or is close enough to the cervix to cause bleeding when the cervix dilated or the lower uterine segment effaces. (Hull and Resnik, 2009)
  4. 4. INCIDENCE • In 80% cases it is found in multiparous women. • The incidence is increased beyond the age of 35, with high birth order pregnancies and in multiple pregnancy. • The incidences approximately 4-5 per thousand pregnancies.
  5. 5. RISK FACTORS • Multiparity • Increased maternal age • Higher altitude • History of previous scar in the uterus. • Smoking
  6. 6. TYPES There are four types of placenta praevia depending upon the degree of extension of placenta to the lower segment. • Type 1 (Low lying) • Type 2 (Marginal) • Type 3 ( Incomplete or partial central ) • Type 4 ( Central or total)
  7. 7. CONTD.. Type 1 (Low lying) : The major part of placenta is attached to the upper segment and only the lower margin encroaches onto the lower segment but not to the os.
  8. 8. CONTD… Type 2 (Marginal) : The placenta reaches the margin of internal os but does not cover it.
  9. 9. CONTD… Type 3 ( Incomplete or partial central ) : The placenta covers the internal os partially ( cover the internal os when closed but does not entirely do so when fully dilated)
  10. 10. CONTD… Type 4 ( Central or total) : The placenta completely covers the internal os even after it is fully dilated.
  11. 11. CLINICAL FEATURES Symptoms Vaginal bleeding: • sudden in onset, painless • revealed bleeding (fresh blood) • Bright red or dark colored • Unrelated to activity
  12. 12. CONTD… Signs: • General condition and anaemia are proportionate to the visible blood loss Abdominal examination: the size of the uterus • Uterus feels relaxed and soft. • The head is floating in contrast to the period of gestation. • Fetal heart sound is usually present.
  13. 13. CONTD… • Vaginal inspection: Placenta is felt on the lower segment.
  14. 14. COMPLICATIONS Complications of Placenta Praevia: 1.Maternal complications: • During Pregnancy • During labour • Puerperium 2. Fetal complications
  15. 15. MATERNAL COMPLICATIONS During pregnancy: • Antepartum haemorrhage • Malpresentation • Premature labour
  16. 16. CONTD… During labour: • Early rupture of membranes • Cord prolapse • Slow dilatation of the cervix • Intrapartum haemorrhage
  17. 17. CONTD… Puerperium: • Postpartum haemorrhage • Retained placenta • Subinvolution
  18. 18. Fetal complication • Low birth weight • Asphyxia • Intrauterine death
  19. 19. DIAGNOSIS Placentography : Sonography Color Doppler flow study Magnetic resonance Vaginal examination
  20. 20. MANAGEMENT • Prevention • Immediate management • Expectant management • Active management • Nursing Management
  21. 21. PREVENTION To minimize the risks , the following guidelines are useful. • Adequate antenatal care • Significance of warning haemorrhage At Home – • Put the patient on bed . • Abdominal examination • Vaginal examination must not be done. Transfer To Hospital • Admission To Hospital
  22. 22. IMMEDIATE ATTENTION • To ensure an adequate blood supply to a women and fetus place the women immediately on bed rest in a side lying position. • A large bore IV cannula is cited and infusion of normal saline • Gentle abdominal palpation
  23. 23. Scheme Of Management All APH patients are to be admitted General and abdominal examination Clinical assessment of blood loss Resuscitation if necessary Localisation of placenta • Expectant management Active interference
  24. 24. Expectant management The expectant treatment is carried upto 37 weeks. Aim: The aim is to continue pregnancy for fetal maturity without compromising the maternal health. Indications: • No active bleeding • Patient stable haemo-dynamically • FHS- good • CTG- reactive fetus
  25. 25. CONTD… Interventions: • Bed rest • Periodic inspection of vulvul pads • Supplementary haematinics if patient is anaemic • Use of tocolytics. • Rh immunoglobulins to all Rh negative women.
  26. 26. Active management Indications: • Bleeding occurs at or after 37 weeks of pregnancy • Patient is in labour • FHS- absent • Gross fetal malformation • Dead fetus
  27. 27. CONTD… Active management Vaginal delivery Caesarean delivery Placental edge is within 2 cm from the internal os: in this case no internal examination is performed and caesarean section is considered as the best choice.
  28. 28. CONTD… Placental edge is 2-3 cm away from the internal cervical os: Internal examination in OT ARM with or without oxytocin Satisfactory progress of labour bleeding continues & no labour initiation vaginal delivery caesarean delivery
  29. 29. NURSING MANAGEMENT Nursing Diagnosis Decreased cardiac output related to blood loss as manifested by increase in heart rate. Interventions: • Monitor Vital Signs • Provide adequate rest & • reposition client • Encourage relaxation techniques • Elevate Hb of the client •
  30. 30. Ineffective tissue perfusion related to decrease in Hb in blood as manifested by dyspnea. Interventions: • Monitor Vital Signs. • Encourage quiet & restful environment. • Encourage use of relaxation techniques. • Provide supplemental oxygen to the client as prescribed by the physician.
  31. 31. Deficient fluid volume related to Blood Loss as manifested by vital signs changes. Interventions: • Monitor Vital Signs • Monitor FHR. • Initiate IV fluids as ordered by the physician. • Place the patient in left lateral position.
  32. 32. Fear related to outcome of pregnancy as manifested by facial expressions of the mother. Nursing Interventions • Assess fetal heart sounds. • Allow the mother to share her feelings. • Answer the mother’s questions honestly. • Include the mother in the planning of the care plan for both the mother and the baby.
  33. 33. Bibliography • Perry, Hockenberry, Lowdermilk et al. Maternal Child Nursing Care. Elsevier. 5th edition; 326-329 • Cunningham, Leveno, Bloom et al. Williams Obstetrics. Mc graw Hill Education. 24th edition; 801-807 • D.C.Dutta’s . Textbook of Obstetrics. New central Book Agency(P) Ltd. 7th edition; 241-250 • Renu mishra.IAN DONALD’S Practical Obstetric problems. Wolters kluwer. 7th edition ; 315-320 • Adele pillitteri. Maternal and child health nursing. Walters kluwer. 7th edition;562-565.
  34. 34. THANK YOU
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Placenta previa

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