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Placenta Previa

Placenta Previa

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Published by miss RN
This is a report I did about Placenta Previa back when I was in college.
This is a report I did about Placenta Previa back when I was in college.

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Published by: miss RN on Feb 08, 2009
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06/18/2013

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PLACENTA PREVIA
Definition:
Is an abnormal low implantation of the placenta in proximity to the internal cervical os.
Placenta previa is a condition in which the placenta attaches to the uterine wall in the lower portion of the uterusand covers all or part of the cervix.Classification of Placenta Previa1.Total Previa- the placenta completely covers the internal cervical os.2.Partial Previa- the placenta covers a part of the internal cervical os.3.Marginal Previa- the edge of the placenta lies at the margin of the internal cervical os and may be exposedduring dilatation.
4.
Low-lying placenta- the placenta is implanted in the lower uterine segment but does not reach to the internal osof the cervix.Risk factors1.Advanced maternal age2.multiparity3.previous uterine surgery4.large placenta (multiple gestation, erythroblastosis)5.maternal smokingTrue placenta previa at term is very serious. Complications for the baby include:
Problems for the baby, secondary to acute blood loss
Intrauterine growth retardation due to poor placental perfusion
Increased incidence of congenital anomaliesSigns and SymptomsSigns and symptoms of placenta previa vary, but the most common symptom is painless bleeding during the thirdtrimester. Other reasons to suspect placenta previa would be:
Premature contractions
Baby is breech, or in transverse position
Uterus measures larger than it should according to gestational ageManagement:1.may be given drugs that can prevent premature labor or birth example is progesterone.2.Ultrasound exams to determine migration of an early diagnosed previa or classification of the previa as total,partial, marginal, or low-lying.3.With a small first bleed, client may sent home on bed rest if she can return to hospital quickly.
 
4.If bleeding is more profuse client is hospitalized on bed rest with BRP, IV access; labs: Hgb and Hct, urinalysis,blood group and type and cross match for 2 units of blood hold, possible transfusions; goal is to maintain thepregnancy fetal maturity.5.No vaginal exams are performed except under special conditions requiring a double set-up for immediatecesarean birth should hemorrhage result.6.Low lying or marginal previas may allowed to deliver vaginally if the fetal head acts as tamponade to preventhemorrhage.7.Cesarean birth, often with vertical uterine incision, is used for total placenta previa.8.Steroid shots may be given to help mature the baby's lungs.
Anatomy and PhysiologyNormal Placenta During ChildbirthProcess of placental growth and uterine wall changes during pregnancy
1.The placenta grows with the placental site during pregnancy.2.During pregnancy and early labor the area of the placental site probably changes little, even duringuterine contractions.3.The semirigid, noncontractile placenta cannot alter its surface area.
Anatomy of the uterine/placental compartment at the time of birth
1.The cotyledons of the maternal surface of the placenta extend into the decidua basalis, which forms a naturalcleavage plane between the placenta and the uterine wall.2.There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the branches of the uterinearteries that run through the wall of the uterus to the placental area.3.The placental site is usually located on either the anterior or the posterior uterine wall.
4.
The amniotic membranes are adhered to the inner wall of the uterus except where the placenta is located
Possible Nursing Diagnosis
Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation
Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation
Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss
Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to Potential for Hemorrhage
Altered Diversional Activity r/t Inability to Engage in Usual Activities Secondary to Enforced Bed Rest andInactivity During Pregnancy
 
Risk Factors
AdvancedMaternal AgeMultiparityPrevious Uterine
 Surgery
Large Placenta(Multiple Gestation,
 Erythroblastosis)
Painless VaginalBleedingComplete PreviaPartial PreviaMarginal PreviaLow-lying placentaBleeding StopsFetus StableObserve
Cesarean Birth
Intrauterine Growth Retardation(IGR)Tachycardia (↑ Pulse)
Vaginal or Cesarean birth
↑ Capillary refillPale, cool skinCongenital AnomaliesMaternal Mortality (rare)Maternal HemorrhageHypotension (↓BP)↓ Urine OutputBleeding continuesBleeding restartsBed Rest
 
MaternalSmoking
Ultrasound
Complications:
PATHOPHYSIOLOGY OF PLACENTA PREVIA

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