Unit3- Hemorrhagic Conditions of Late Pregnancy, Placenta Previa, Placenta Abrupto

Hemorrhagic Conditions of Late Pregnancy

Chapter 24 – pp. 507-528
Chapter 25 – pp. 529-554
Chapter 26 – pp. 555-578

Placenta Previa

• Definition:

  • Implantation of the placenta in the lower part of the uterus leading to potential obstruction of the cervix, which may be either partially or fully obstructed.

  • 

Risk Factors for Placenta Previa

• Multiparity

• History of Cesarean Birth

• Previous Placenta Previa

• Smoking

• Cocaine Use

Signs & Symptoms of Placenta Previa

• Painless Uterine Bleeding: Observed particularly in the latter half of the pregnancy.

• Teach patients to report any vaginal bleeding that is bright red

• No abdominal pain

Diagnosis of Placenta Previa

• Ultrasound Detection: The primary method for identifying placenta previa during pregnancy.

Therapeutic Management of Placenta Previa

• Cesarean Delivery: A planned cesarean section is often necessary if previa is diagnosed.

• Patient is bradycardic and hypotensive

• Low urinary output

• Vaginal pad soaked every 15 minutes

• Have emergency equipment handy

• Baby may be preterm

• Bed Rest: May be indicated if contractions or bleeding occur to decrease complications.

Antepartum Nursing Care - Outpatient Guidelines

• Monitoring: Instruct patients to observe and report:

  • Vaginal discharge or bleeding

  • Changes in fetal activity

  • Any contractions or cramping- do not want labor

• Pelvic Rest: Avoiding vaginal intercourse to minimize risk of bleeding.

• no intercourse

• Penetration is a problem

• no cervial exams

Antepartum Nursing Care - Inpatient Guidelines

• Monitoring:

  • Continuous assessment of bleeding.

  • Fetal surveillance via Non-stress tests and/or biophysical profiles.

• Prepare for Delivery:

  • Anticipate an upcoming cesarean delivery.

  • Obtain consent for potential procedures and blood transfusion.

  • Ensure IV access for medication and fluids.

  • Anticipate neonatal needs due to the potential risks.

• Caveat: No vaginal examinations should be performed to prevent exacerbating bleeding.

Placental Abruption

• Definition:

  • The premature separation of the placenta from the uterine wall before birth, potentially leading to bleeding and hematoma formation on the maternal side of the placenta.

  • Blood Flows out

    

Hematoma

Risk Factors for Placental Abruption

• Hypertension

• Multigravida

• Trauma

• History of Abruption

• Smoking and Cocaine Use

• > 35 years old

Signs & Symptoms of Placental Abruption

• Fundal Height Increase

• Hard, Board-like Abdomen

• Intrauterine Pressure Catheter (IUPC)

• Persistent Abdominal Pain

• Systemic Signs of Early Hemorrhage

• Fetal Heart Rate Patterns:

  • Persistent late decelerations or decreasing baseline variability.

• Vaginal Bleeding: May be present or absent depending on the severity of the condition.

Diagnosis of Placental Abruption

• Presumptive Diagnosis: Based primarily on presenting symptoms and history.

• Ultrasound Utilization: Gold Standard

• Placental Pathology: Examination of the placenta after delivery can provide further insights.

Therapeutic Management of Placental Abruption

• Dependent on Maternal and Fetal Status

• Cesarean Delivery: May be necessary depending on the stability of maternal and fetal conditions.

• Expectant Management: In cases of minor abruption where the mother and baby are stable.

Nursing Care in Cases of Placental Abruption

• Priority: Administer cryoprecipitate intravenously

• Patients must give informed consent

• Side effects: Mild: fever, chills Serious: allergic reaction

• Monitoring: Regular assessment of maternal vital signs and fetal heart rate q 15 minutes

• Monitor appearance of vaginal bleeding

• Monitor uterine resting tone after each contraction

• Monitor maternal abdominal girth every hour

Promote Oxygenation:

• Position the patient lying flat and lateral to improve blood return and oxygenation to the placenta.

• Restrict maternal movement to reduce metabolic demands for oxygen.

• Informational Support: Provide simple explanations and reassurance to the patient and family to alleviate anxiety.

• IV Access: Ensure intravenous access for fluids, medications, and monitoring.

• Just in of fluid and blood being needed

• Anticipate Emergency Delivery: Be prepared for possible urgent intervention and neonatal needs based on the condition's progression.

• Steroids for baby for lung development- surfactant development