Placenta Previa PART 2

What is placenta previa?

A condition where the placenta fully or partially covers the cervix

What does placenta previa cause?

it causes severe painless bleeding, especially after 20 weeks of gestation.

Why is placenta previa considered a serious condition?

It poses a high risk of maternal and fetal morbidity and mortality due to significant blood loss.

What are the three types of placenta previa?

Complete, Partial, Marginal

Complete

The placenta completely covers the cervix.

Partial

The placenta partially covers the cervix.

Marginal

The placenta is located 2 cm away from the cervix.

What organs are involved in placenta previa?

The uterus, cervix, and placenta.

What is the uterus, and what is its function?

The uterus is a hollow, muscular organ responsible for menstruation, receiving the ova, and providing a site for implantation and nourishment for fetal growth.

What role does the uterus play in pregnancy?

It expands to accommodate the growing fetus and supplies oxygen and nutrients through the placenta.

What is the cervix, and what is its function?

The cervix is a cylindrical tissue that connects the vaginal and uterine cavities, allowing passage for sperm, menstrual flow, and childbirth.

How does the cervix contribute to placenta previa complications?

As the cervix dilates during pregnancy, it can tear the placenta, leading to bleeding.

What is the placenta, and what is its function?

The placenta is an organ attached to the uterine wall that provides oxygen and nutrients to the fetus, eliminates waste, and acts as an endocrine organ during pregnancy.

How does the placenta contribute to fetal development?

It functions as the fetal lungs, kidneys, and gastrointestinal system, ensuring survival and growth.

What is the exact cause (Etiology) of placenta previa?

The exact cause is unknown.

What are the predisposing factors for placenta previa?

- Advanced maternal age (35 years and older)

- Non-white ethnicity

- Multiple pregnancies

- Previous cesarean section (C-section)

- History of placenta previa

- Uterine abnormalities (e.g., fibroids, scars)

What does predisposing factor mean?

Non-modifiable

What are the precipitating factors for placenta previa?

- Smoking

- Cocaine use

What does precipitating factor mean?

Modifiable

What are the symptoms of Placenta Previa?

- Vaginal bleeding (abrupt, bright red, painless and sudden after 7 months or after 28th week gestation; scanty beginning before onset of labor)

- Unstable Fetal heart rate when maternal shock present.

- Soft, non-tender uterus.

What is the hallmark symptom of placenta previa & what type of vaginal bleeding occurs in placenta previa?

Abrupt, painless, bright red vaginal bleeding occurring suddenly after 28 weeks of gestation.

What does hallmark symptom mean?

A distinctive characteristic or sign that indicates a disease or condition.

When does vaginal bleeding typically begin in placenta previa?

It can start as scanty bleeding before labor and become more severe later in pregnancy.

What does scanty bleeding/period mean?

Bleeding is very light and almost like spotting

Why does vaginal bleeding occur in placenta previa?

As the cervix dilates, it disrupts the placenta, causing blood loss.

How does placenta previa affect the fetus and fetal heart rate?

It can cause reduced oxygen supply, leading to an unstable fetal heart rate.

What is the condition of the uterus in placenta previa?

The uterus remains soft and non-tender

What does soft and non-tender uterus indicate?

insufficient contractions because of bleeding.

How does stretching of the uterus fix placenta previa?

Stretching elongates the space between the cervix and placenta, relocating the placenta away from the cervical os. Through this relocation, the placenta is pushed up in the uterine wall resolving on its own.

What is the primary imaging laboratory test used to diagnose placenta previa?

Ultrasound (both abdominal and transvaginal) to determine placental position.

When may ultrasound be done?

May be done during prenatal visits or after a vaginal bleeding incident.

Why might multiple ultrasounds be needed for placenta previa?

To check if the placenta has moved away from the cervix as pregnancy progresses.

What laboratory tests are needed for placenta previa?

- Complete blood count

- RH Compatibility tests

- Levels of Fibrin Split products (FSP) and Fibrinogen

- Prothrombin time

What is the purpose of a Complete Blood Count (CBC) in placenta previa?

A cbc can help to determine the patient's hemodynamic status however it is not reliable in estimating acute blood loss.

What does hemodynamic mean?

controls the flow of blood / blood flow

Why is an Rh Compatibility test done in placenta previa?

To determine if the mother and fetus have compatible Rh factors. If incompatible, it can lead to Rh incompatibility complications.

Why is it fatal if Rh incompatible?

The mother's immune system can develop antibodies against the Rh-positive blood cells of the fetus, leading to destruction of those cells.

If the mother is -Rh the baby should also be?

-Rh

How do fibrin split product (FSP) levels and fibrinogen levels laboratory result relate to placenta previa?

Pregnancy is associated with hyperfibrinogenemia, so depressed fibrinogen levels may indicate coagulopathy (blood clotting disorder).

What does hyperfibrinogenemia mean?

Having a higher than normal level of fibrinogen, a protein in the blood that plays a crucial role in forming blood clots.

What is the significance of prothrombin time (PT) in placenta previa?

It measures how long blood takes to clot, which is essential to assess before C-section.

What factors determine the medical and pharmacological management of placenta previa?

Maternal and fetal status, amount of bleeding, gestational age, and placental position.

What medical and pharmacologic management should the patient have?

- IV Fluid Therapy

- Rest

- Corticosteroid shots

- Tranexamic Acid during active bleeding

- Iron Supplementation

- Blood Transfusion

Why is IV fluid therapy important in placenta previa?

It helps maintain hemodynamic stability and adequate urine output.

What does hemodynamic stability mean?

A term used to describe a person's stable blood flow, heart rate, and blood pressure.

Why is rest important if you have placenta previa and what activities should you avoid?

- Sex and exercise, as they may trigger bleeding.

- Lifting heavy objects

How do corticosteroid shots help in placenta previa?

They accelerate fetal lung development if preterm birth is expected.

How does corticosteroids accelerate fetal lung development?

promoting the production and release of surfactant, a substance crucial for lung function and preventing collapse of the alveoli during breathing.

What classification of drugs are corticosteroids?

anti-inflammatory

Examples of corticosteroids used in mothers for preterm babies?

betamethasone and dexamethasone

What is the role of tranexamic acid in placenta previa?

It helps reduce blood loss by promoting blood clotting during active bleeding.

Why is iron supplementation given to placenta previa patients?

To correct anemia caused by blood loss.

How does iron fix anemia?

Iron fixes iron-deficiency anemia by replenishing the body's iron stores, which are essential for the production of hemoglobin, the protein in red blood cells that carries oxygen.

When is blood transfusion needed in placenta previa?

To replace lost blood and prevent hypovolemia.

NURSING RESPONSIBILITIES before giving blood tranfusion to PT?

- Before blood transfusion, check for the mother's blood type.

- Vital signs are regularly monitored before, during, and after transmission

- Transfusion should be guided by the volume of blood loss over time, changes in hemodynamic parameters (eg. blood pressure, maternal and fetal heart rates, peripheral perfusion, and urine output), coagulation studies, and hemoglobin level

- Watch for any signs of allergic reaction - rash, fever, headache, and swelling.

What happens if wrong blood type given during transfusion?

The recipient's immune system will attack the foreign blood cells, potentially leading to a life-threatening reaction including fever, chills, kidney failure, and shock.

What vital signs should be monitored during a transfusion?

Blood pressure, maternal & fetal heart rates, peripheral perfusion, urine output, and hemoglobin levels.

What are signs of an allergic reaction to a blood transfusion?

Rash, fever, headache, and swelling.

What surgical management is done for the patient placenta previa?

C-section

When is a C-section indicated in placenta previa?

- Active labor

- Severe and persistent vaginal bleeding that affects maternal stability

What does active labor mean?

Active labor signifies a transition in the first stage of labor where contractions become stronger, more frequent, and longer, with the cervix dilating more rapidly, typically from 4 to 6 centimeters to 8 centimeters.

What are the three phases of labor?

Latent, Active, and Transition

Preoperative Interventions of CS?

1. Obtain consent for surgery.

2. Advise mother to be on NPO. Restrict fluid upon admission.

3. Upon transport to surgery, ensure that the woman is lying on her left side to prevent supine hypotension.

4. Facilitate cross-matching and typing for possible blood transfusion.

5. Initiate IV fluid therapy as ordered.

6. Monitor fetal status closely.

What should be obtained before a C-section?

Informed consent for surgery.

Why is the mother placed on NPO (nothing by mouth) before surgery?

To prevent aspiration during anesthesia.

What dies is the mother on after surgery?

Full liquid diet

Diet stages?

-

How should the mother be positioned for transport to surgery?

On her left side to prevent supine hypotension.

What laboratory preparation should be done before a C-section?

Blood typing and cross-matching for possible blood transfusion.

Why is IV fluid therapy initiated before surgery?

To ensure hydration and hemodynamic stability.

Why is fetal monitoring crucial before surgery?

To assess fetal distress and prepare for emergency interventions if needed.

Postoperative Interventions of CS?

Postoperative Interventions:

1. Close monitoring of vital signs.

2. Use a pain-rating scale to allow mother to rate pain. Supplement analgesics (NSAIDS and Acetaminophen ) as ordered.

3. Instruct mother to ambulate. Ambulation is most effective to relieve gastric pain

4. Educate comfort measures such as change in position.

What is the primary focus after C-section?

Close monitoring of vital signs for signs of complications.

What method helps manage postoperative pain?

Pain-rating scale to assess pain and administer NSAIDs or acetaminophen as ordered.

What does NSAID do?

relieve pain, reduce inflammation, and lower fever

Why is early ambulation encouraged after C-section?

It helps relieve gastric pain and prevents blood clots.

How can comfort be improved after surgery?

Position changes and pain management techniques.