PLACENTA PREVIA (copy)

placenta previa def

a condition of pregnancy in which placenta is implanted abnormally in the lower part of the uterus. it is the most common cause of painless bleeding in the third trimester of pregnancy

risk/predisposing factors

multiparity

decreased vascularity in the upper uterine segment as in scarring and tumor

increased age: 35 years

multiple pregnancy

scarring of the upper lining tissues of the uterus

TYPES (TYPE 1) LOW LYING

placenta at the lower third of the uterus does not cover the internal os

TYPE 2 (MARGINAL)

placenta lies over the margins of the internal os

TYPE 3 (INCOMPLETE/PARTIAL)

placenta partly covers the internal os

TYPE 4(COMPLEte or total)

placenta totally covers the internal os

SIGNS and symptoms

uterus feels relaxed and soft; intermittent hardening if in labor

the head is floating in contrast to period of gestation

fetal heart is usually present

vaginal inspection: placenta is felt on the lower segment

painless vaginal bleeding

intermittent pain

PREVENTION

adequate antenatal care

significance of warning hemorrhage put the patient on bed

abdominal examination

vaginal examination must not be done

COMPLICATIONS

hemorrhage

prematurity

obstruction of the birth canal

diagnostic

ultrasound

vaginal examination

abdominal presentation

THERAPEUTIC MANAGEMENT

pharmacologic therapy

surgical management

nursing implentation

maintain bedrest

careful assessment

institute shock measures as necessary

provide psychosocial and physical comfort

prepare for conservative management double set up or classical CS

observe bleeding after delivery:the lower uterine segment, the site of placental detachment, is not contractile as the upper final portion

PHARMACOLOGIC THERPAY

ensure an adequate blood supply to a woman and fetus.place the women immediately on bed rest in a side lying position

large bore IV cannula is cited and infusion of normal saline

SURGICAL MANAGEMENT

the patient is not in labor look amount of bleeding

if the bleeding is severe continue antishock measures and do an immediate cesarean section