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PLACENTA PREVIA

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PLACENTA PREVIA PRESENTED BY: JISHA MARIA LR/DR DEPARTMENT The placenta signifies the – PowerPoint PPT presentation

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Title: PLACENTA PREVIA


1
PLACENTA PREVIA
  • PRESENTED BY
  • JISHA MARIA
  • LR/DR DEPARTMENT

2
DEMOGRAPHIC DATA
3
NAME MS. P.A. AGE 47/F
CASE NO 193
Dx G9P7A1 29 weeks 3 days, PTL T/C Placenta
Previa, Previous LCCS
4
PHYSICAL ASSESSMENT
5
GENERAL
  • The patient is 47 y/o, FEMALE, weight 74 kg.
  • She is conscious, coherent
  • With the following Vital Signs
  • BP 120/80 mmHg
  • PR72 bpm
  • RR 23 /cpm
  • Temp36.8C

6
SKIN
  • Pallor of skin and nails
  • No palpable masses or lesions

7
HEAD
  • Maxillary, frontal, and ethmoid sinuses are not
    tender
  • No palpable masses or lesions
  • No areas of deformity

8
LOC ORIENTATION
  • Awake and alert
  • Oriented to Persons, Place, Time

9
EYES
  • Pale conjunctivae and no dryness
  • Pupils equally round and reactive to light

10
EARS
  • No unusual discharges noted

11
NOSE
  • Pink nasal mucosa
  • No unusual nasal discharge
  • No tenderness in sinuses

12
MOUTH
  • Dry mouth and lips
  • Free of swelling and lesions

13
NECK AND THROAT
  • No palpable lymph nodes
  • No masses and lesions seen

14
CHEST AND LUNGS
  • Symmetrical chest wall upon movement
  • Clear breath sounds
  • Absence of chest pain

15
HEART
  • Regular rhythm

16
ABDOMEN
  • Abdomen is soft
  • With mild to moderate uterine contraction
  • With mild hypogastric pain

17
ABDOMEN
  • With active bowel sounds
  • No abdominal tenderness

18
GENITOURINARY
  • No discharges or foul smell
  • With minimal vaginal spotting up to 2-13 pads per
    day
  • Able to void freely
  • No pain in urination

19
EXTREMITIES
  • Pulse full and equal
  • No lesions noted

20
PATIENT HISTORY
21
PAST MEDICAL HISTORY
  • With history of Abortion
  • At 3 yr before
  • With 5 times Surgical history of LSCS

22
OBSTETRICAL HISTORY
DATES OF PRIOR PREGNANCIES GESTATIONAL AGE ROUTE COMPLICATIONS WEIGHT
G1 TERM NSD
G2 TERM LSCS 1X MALPRESENTATION (TRANSVERSE LIE)
G3 TERM VBAC
G4 TERM LSCS 2X MALPRESENTATION (BREECH) 2.5 3.5 KGS
G5 TERM LSCS 3X
G6 TERM LSCS 4X
G7 ABORTION AT 2 MOS. (-) D C
G8 TERM LSCS 5X
G9 PRESENT PREGNANCY
23
PRESENT MEDICAL HISTORY
  • C/O Mild Hypogastric Pain
  • MEDICAL HISTORY G9P7A1 29 3/7 weeks Age of
    Gestation
  • ON EXAMINATION BP 120/80mmHg, PR 72 bpm, RR
    23 cpm, Temp. 36.8 C
  • LMP Unknown
  • PV not done
  • No allergies to any food or drug
  • With Hypertensive and Diabetic parents

24
MEDICATIONS
DRUG IMAGE DOSE ACTION
Tab. NIFEDIPINE T 10mg TID x 48 hours PO Decreases arterial smooth muscle contractility and subsequent vasoconstriction
Inj. DEXAMETHASONE 6mg every 6 hours for 3 doses IV A synthetic glucocorticoid which decreases inflammation by inhibiting the migration of leukocytes and reversal of increased capillary permeability
25
MEDICATIONS
DRUG IMAGE DOSE ACTION
AGIOLAX 2tsp BID PO Suitable for bowel regulation during pregnancy and post partum
Tab. FERROUS SULFATE I tab OD PO Provides supplemental iron, an essential component in the formation of hemoglobin
26
INVESTIGATIONS
27
LABORATORY RESULT REFENCE RANGE
CBC HGB HCT PLT 11.8g/dl 35.9 292 11.2-15.7 g/dL 34.1-44.9 182-369/UL
Blood Group O
Rh Type Positive
PT 13.3 sec 10.9 16.3 Seconds
APTT 30.4 sec 27 39 Seconds
28
INVESTIGATIONS
  • Ultrasonographic Result
  • PU 31weeks 5days AOG by fetal biometry
  • Live Singleton in cephalic presentation, Male
    fetus
  • Good Cardiac and somatic activity
  • Left Lateral Placenta, Grade II, Previa Totalis
  • Adequate fluid volume
  • BPP 8/8

29
Actual Ultrasound Result
30
INVESTIGATIONS
  • MRI Result
  • Pelvis shows gravid uterus with single fetus and
    the placenta is in left lateral position and in
    lower uterine segment completely covering the
    internal os and shows heterogenous sigal
    intensity with bulging of lower uterine segment
    and irregular thick intraplacental T2 dark bands
    and loss of thin subplacental myometrial zone and
    tenting of the urinary bladder seen along its
    ntero-superior margin, most probably suggestive
    of placenta previa.

31
INTRODUCTION
  • The term placenta previa refers to a placenta
    that overlies or is proximate to the internal os
    of the cervix. The placenta normally implants in
    the upper uterine segment. In placenta previa,
    the placenta either totally or partially lies
    within the lower uterine segment. Traditionally,
    placenta previa has been categorized into 4
    types
  • Complete placenta previa
  • where the placenta completely covers the internal
    os.
  • Partial placenta previa
  • where the placenta partially covers the internal
    os. Thus, this scenario happens only when the
    internal os is dilated to some degree.
  • Marginal placenta previa
  • which just reaches the internal os, but does not
    cover it.
  • Low lying placenta
  • which extends into the lower uterine segment but
    does not reach the internal os.

32
ANATOMY AND PHYSIOLOGY
33
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34
  • The placenta signifies the "second" or
    "embryonic" period of pregnancy (after the
    implantation period) and describes the
    establishment of a fully functional placenta. The
    placenta is an apposition of foetal and parental
    tissue for the purposes of physiological
    exchange. There is little mixing of maternal and
    foetal blood, and for most purposes the two can
    be considered as separate.
  • The placenta can be thought of as a "symbiotic
    parasite", unique to mammalia. The placenta
    provides an interface for the exchange of gases,
    food and waste. It also facilitates the de novo
    production of fuel substrates and hormones and
    filters potentially toxic substances.
  • The placenta has two distinct seperate
    compartments the fetal side consisting of the
    trophoblast and chorionic villi and the maternal
    side consisting of the decidua basalis.

35
  • The placenta consists of a foetal portion formed
    by the chorion and a maternal portion formed by
    the decidua basalis. The uteroplacental
    circulatory system begins to develop from
    approximately day 9 via the formation of vascular
    spaces called "trophoblastic lacunae".
  • Maternal sinusoids develop from capillaries of
    the maternal side which anastamose with these
    trophoblastic lacunae. The differential pressure
    between the arterial and venous channels that
    communicate with the lacunae establishes
    directional flow from the arteries into the veins
    resulting in a uteroplacental circulation.

36
Placental Blood Supply
  • Maternal blood carrying oxygen and nutrient
    substrate to the placenta must be transferred to
    the fetal compartment and this rate of transfer
    is the rate limiting step in the process.
    Therefore the placenta has a significant blood to
    facilitate improved exchange.
  • Fetal blood enters the placenta via a pair of
    umbilical arteries which have numerous branches
    resulting in fetal chorionic villi within the
    placenta, terminating at the chorionic plate. The
    fetal chorionic villi are then surrounded by
    maternal tissues. This physiology is referred to
    as "invasive decidualisation" as the fetal
    chorionic villi effectively invade the maternal
    tissues. Invasive decidualisation is not present
    in pigs or sheep.

37
Placental Blood Supply
  • Oxygen and nutrient rich blood returns to the
    fetus via the umbilical vein. Maternal blood is
    supplied to the placenta via 80-100 spiral
    endometrial arteries which allow the blood to
    flow into intervillous spaces facilitating
    exchnage. The blood pressure within the spiral
    arteries is much higher than that found in the
    intervillous spaces resulting in more efficient
    nutrient exchange within the placenta.

38
ETIOLOGY
  • Increased maternal age
  • Uterine factors
  • Previous CS
  • Instrumentation of the uterine cavity (D and C
    for miscarriages or Induced Abortions)
  • Placental factors
  • Multiparity
  • Cigarette smoking
  • Living at high altitude

39
SIGNS AND SYMPTOMS
  1. Vaginal bleeding
  2. Painless but can be associated with uterine
    contractions and abdominal pain
  3. Bleeding may range from light to severe
  4. Gross hematuria

40
INTERVENTION
  • Bed rest in lateral position to maximize venous
    return and placental perfusion
  • Women in the third trimester are advised to avoid
    sexual intercourse and exercise and to reduce
    their activity level

41
TREATMENT
  • Depends upon the extent and severity of
    bleeding, the gestational age and condition of
    the fetus, position of the placenta and fetus and
    whether the bleeding has stopped.
  • Caesarean section as soon as he baby can be
    safely delivered (typically after 36weeks
    gestation). Although emergency CS at any earlier
    gestational age may be necessary for heavy
    bleeding that cannot be stopped.
  • Hysterectomy

42
COMPLICATIONS
  • Maternal
  • Increased risk of PROM leading to premature labor
  • Immediate hemorrhage with possible shock and
    maternal death
  • Postpartum hemorrhage
  • Placenta Accreta
  • Accreta Vera a term used to denote a placenta
    with villi that adhere to the superficial
    myometrium
  • Increta when the villi adheres to the body of
    the myometrium, but not through its full
    thickness
  • Percreta when the villi penetrate the full
    thickness of the myometrium and may invade
    neighboring organs such as the bladder or the
    rectum

43
  • Fetal
  • Abnormal fetal presentation (breech)
  • Reduced fetal growth
  • Prematurity

44
PRIORITIZATION OF NURSING PROBLEMS
  1. Impaired fetal gas exchange related to altered
    blood flow and decreased surface area of gas
    exchange at site of placental detachment
  2. Ineffective Tissue Perfusion related to excessive
    bleeding causing fetal compromise
  3. Deficient Fluid Volume related to excessive
    bleeding
  4. Anxiety related to excessive bleeding,
    procedures, and possible fetal-maternal
    complications

45
ASSESSMENT NURSING DIAGNOSIS GOALS DESIRED OUTCOME NURSING INTERVENTION RATIONALE EVALUATION
SUBJECTIVE I am having too much bleeding in my vagina- as verbalized by the patient OBJECTIVE 1.Restlessness 2.Confusion 3.Irritability 4.Manifest Body Weakness 5.Capillary refill more than 3 sec 6.Oliguria V/S taken as follows BP90/60mm of Hg PR110bpm RR20/mt Temp36.5 C Ineffective tissue perfusion related to decreased HgB concentration in blood hypovolemia secondary to Placenta previa. Short Term After 12hrs of nursing Intervention the pt Will demonstrate Behaviors to improve Circulation. Long term After 4 days of nursing Intervention the pt will demonstrate increased perfusion as individually appropriate 1.Establish Rapport 2.Monitor vital signs 3.Assess patient condition 4.Note customary baseline Data (usual BP, weight,lab values) 5.Determine presence of dysrhthmias 6.Perform blanch test 7.Check for Homans Sign 8.Encourage quiet restful enviornment 9.Elevate head of bed 10. Encourage use of relaxationm teqniques 1.To gain patients trust 2.To obtain baseline data 3.To assess contributing factors 4. For comparison with current findings 5.To identify alterations from normal 6.To identify/determine adequate perfusion 7.To determine presence of thrombus formation 8.To lessen O2 demand 9.To promote circulation 10.To decrease tension level Short term The pt shall have demonstrated behaviors to improve circulation. Long term The pt shall have an increased perfusion as individually appropriate.
46
CONCLUSION
  • Presented a case of a 47 y/o Multigravida,
    G9P7A1, with pregnancy 29 wks 3 days with PTL
    t/c PLACENTA PREVIA, Previous LSCS
  • The treatment depends upon the extent and
    severity of bleeding, the gestational age and
    condition of the fetus, position of the placenta
    and fetus and whether the bleeding has stopped.
  • Placenta Previa is a medical emergency that needs
    immediate management because it can lead to
    serious maternal and fetal complications, even
    death of one or both of them.
  • Nurse-led patient education and the provision of
    a supportive environment are essential to the
    optimal management of Placenta Previa
  • Individually tailored and compassionate nursing
    care of women with Placenta Previa will serve to
    enhance the wellbeing of mother and baby

47
  • THANK YOU!
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