Introduction

My objectives in this case are to know the reason why it is happening during pregnancy.
The placenta is implanted in the lower uterine segment near or over the internal cervical
os. The degree to which the internal cervical os is covered by the placenta has been used
to classify four types of placenta previa; total, partial, marginal and low–lying. In total
previa the internal os is entirely covered by the placenta. Partial placenta previa implies
incomplete coverage of the internal os. Marginal placenta previa indicates that only an
edge of the placenta extends to the margin of the internal os. And the last is the low – lying
placenta has been used when the placenta is implanted in the lower uterine segment but
not reach the os. The more descriptive classification that includes placenta previa is in the
third trimester.The incidence of placenta previa is approximately 0.5% of births. The most
important risk factors are previous placenta previa, previous cesarean birth, and suction
curettage for miscarriage or induced abortion, possible related to endometrial scarring.
The risk also increases with multiple gestations because of the larger placental area,
closely spaced pregnancies, advanced maternal age older than 34 years, African or Asian
ethnicity, male fetal sex, smoking, cocaine use, multiparity, and tobacco use. The brief
pathophysiology of abruption placentae; No specific cause of placenta previa has yet been
found but it is hypothesized to be related to abnormal vascularisation of the endometrium
caused by scarring or atrophy from previous trauma, surgery, or infection. In the last
trimester of pregnancy the isthmus of the uterus unfolds and forms the lower segment. In a
normal pregnancy the placenta does not overlie it, so there is no bleeding. If the placenta
does overlie the lower segment, it may shear off and a small section may bleed. Women
with placenta previa often present with painless, bright red vaginal bleeding. This bleeding
often starts mildly and may increase as the area of placental separation increases. Previa
should be suspected if there is bleeding after 24 weeks of gestation. Abdominal
examination usually finds the uterus non-tender and relaxed. Leopold’s Maneuvers may
find the fetus in an oblique or breech position or lying transverse as a result of the
abnormal position of the placenta. Previa can be confirmed with an ultrasound.[3] In parts
of the world where ultrasound is unavailable, it is not uncommon to confirm the diagnosis
with an examination in the surgical theatre. The proper timing of an examination in theatre
is important. If the woman is not bleeding severely she can be managed non-operatively
until the 36th week. By this time the baby’s chance of survival is as good as at full term.
Perinatal morbidity and mortality in the Philippines In 11/42 or 26.2% of cases, the cause
of fetal death was severe asphyxia due to abruptio placenta, severe toxemia giving rise to
placental insufficiency, or obstructed labor. Predisposing Factors: Multiparity (80% of
affected clients are multiparous), Advanced maternal age (older than 35 years old in 33%
of cases Multiple gestation, Previous Cesarean birth, Uterine Incision, Prior placenta
previa ( incidence is 12 times greater in women with previous placenta previa)
Patient Profile

Ward: General Nursing Unit

Date of Admission: August 14,2010

Patient Name: CGC

Address: South Cembo

Age: 29y/o

Gender: Female

Birth date: October 16, 1981

Educational Status: High School Undergrad

Religion: Roman Catholic

Nationality: Filipino

Civil Status: Married

Occupation: House wife

Health Care Financing:

Informant: Herself

Reliability: 100%

Admission:

Chief Complaint: Acute Pain

Initial Diagnosis:

Final Diagnosis:

Attending Physician:
 Gordon’s Functional Health Pattern

ASPECT PRIOR TO DURING INTERPRETATION

HOSPITALIZATION HOSPITALIZATION and ANALYSIS

1. Nutritional and Patient loves to eat The patient is on The patient cannot eat
Metabolic meat, fish and NGT feeding. foods that is not
Pattern vegetables. He eats blended.
anything that is being
served to her. He does
not eat junk foods.He is
not taking food
supplements like
vitamins frequently.
He eats 2 cups of rice
with viand. He eats
thrice a day.
2. Elimination Patient voids 7 times a The patient urinates The patient does not
Pattern day, and defecate twice 6-8 times a day. He defecate as many as
a week. He doesn’t defecate 0-1 time a he did before. For most
experience any pain and day. people defecation is a
difficulty in terms of private affair
urination. Previously his experienced easily only
defecation pattern is in the comfort of one’s
daily, but when her own bathroom.
condition exacerbated, it
is also affected.

3. Activity and He does not have Deep breathing and The patient performs
Exercise routine exercise. coughing exercises deep breathing
Pattern However, he is aware are advised and exercise as instructed
that his activity is not performed. The by the nurse.
enough, and he patient has
recognizes the decreasing function
importance of having as the disease
regular exercise. He progresses.
loves to watch on the
television.

4. Hygiene Patient takes a bath Not applicable

every day, brushes
 histeeth twice a day. He
wears slippers while
inside their house. He
feels that her hygienic
practices are adequate,
and he feels clean and
neat. There is no body
odor noted.
5. Substance Patient is a smoker but The patient doesn’t The patient does not
Use he stop on May 16. He use any prohibited use any addictive
drinks occasionally and substances like substances. Illicit drugs
consumed 2 bottles alcohol, cigarettes are strictly prohibited in
(emperador, lapad). He and illicit drugs. the hospital premises,
do not use any illegal even cigarette smoking
drugs. and alcohol drinking.
6. Sleep and The patient has a Not applicable
Rest problem in sleeping
because he has an
insomnia. He usually
falls asleep around 3:00
– 4:00 a.m. and wakes
up around 6:00-7:00 in
the morning. He
consume 2-3 hours of
sleep in a night.He takes
a nap usually at around
3:00 p.m. He consume
1-2 hours of nap in a
day.
7. Sexuality- He dresses Not applicable
Reproductive appropriately, based on
Pattern his gender. He does not
use any contraceptives.

V. Physical Assessment
Area to be Assessed Normal Findings Actual Findings Analysis/
Inference
General Appearance (+) Weight loss The patient has
Temp. – 36.5 an obvious weight
loss. He also has
BP – 150/100
a high blood
PP – 80 pressure
RR – 18
Skin No lesion No lesion No significant
findings
Hair Evenly distributed without Evenly distributed with No significant
some patches of loss hair some patches of loss hair findings
Silky and smooth Silky and smooth No significant
No presence of lice findings
No presence of lice No significant
findings
Teeth 32 adult teeth; smooth, Has 31 adult teeth. The It is also related
white, shiny tooth patient has yellowish to dental carries
enamel; smooth, intact teeth. and frequency of
dentures tooth brushing.
Skull and Face Rounded(normocephalic) Rounded(normocephalic) No significant
; smooth skull contour ; smooth skull contour findings
Has no tenderness Has no tenderness No significant
No presence of edema findings
No presence of No presence of edema No significant
Hollowness findings
Has Hollowness Abnormal, due to
weight loss
Eyes and Visual No blurring of vision No blurring of vision No significant
Acuity Movements are findings
symmetrical Movements are No significant
Turned outward symmetrical findings
eyelashes; hair equally
distributed Turned outward No significant
eyelashes; hair equally findings
Able to close the eyes distributed
and has the ability to
blink Able to close the eyes No significant
and has the ability to findings
blink
Ears No trumors No trumors No significant
findings
Nose No epistasas No epistasas No significant
findings
Throat No sore throat Has no sore throat No significant
findings
Respiratory No cough Has cough Due to the PTB
No presence of murmur
of sounds when breathing
Cardiovascular No palpitation No palpitation No significant
findings
Gastro Intestinal No constipation No constipation No significant
No diarrhea No diarrhea findings
Heart Dynamic pericardium Dynamic pericardium No significant
findings
Normal Rate
Normal Rate No significant
Regular rhythm findings
No murmur No significant
Regular rhythm
findings
No murmur No significant
findings
Abdomen Flabby Flabby No significant
findings
Narrow active bowel
sound Narrow active bowel No significant
sound findings
Soft
Soft No significant
findings

Reference:

Fundamentals of Nursing by Kozier and Erb

Mosby’s PDQ for RN 2nd Edition

Computation:
BMI= Weight (kg) = 10.35kg = 10.35kg = 10.56

Height(m)² (.99m)² .9801m²

VI Anatomy and Physiology

ABRUPTIO PLACENTAE

a. Abruptio placentae is hemorrhage resulting from the detachment of the placenta.

Hypertension may cause this. It may occur any time during pregnancy. If the placenta
becomes detached prior to the 20th week of gestation it is called a spontaneous abortion.

b. Abruptio placentae may be classified in three types of separation (see 0figure 1-6).

(1) Marginal/low separation. This occurs when the separation is low and is not complete;
vaginal hemorrhage is evident.

(2) Moderate/high separation. This occurs when the separation is high in the uterine
segment, causing the fundus of the uterus to rise. The fetus is in grave danger because of
lack of oxygen. External hemorrhage will probably not be present here, whereas the
amniotic fluid will be a port-wine color.

(3) Severe/complete separation. This occurs when the fetus head is present in the cervical
os that prevents external hemorrhage. The fetus is in grave danger, and an immediate
cesarean section will probably be needed in order to save the baby's and mother's lives.

Reference:
http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_1
_Section_1A.htm
Pathophysiology
 Laboratory Studies

 Hemoglobin
 Hematocrit
 Platelets
 Prothrombin time/activated partial thromboplastin time
 Fibrinogen
 Fibrin/fibrinogen degradation products
 D-dimer
 Blood type

Imaging Studies

 Ultrasonography helps determine the location of the placenta to exclude placenta

previa. Ultrasonography is not very useful in diagnosing placental abruption.
o Retroplacental hematoma may be recognized in 2-25% of all abruptions.
o Recognition of retroplacental hematoma depends on the degree of hematoma
and on the operator's skill level.
 Discharge Planning

Medications Tramadol 50 mg/tab for every 4 hours

Fentanyl Patch for every 3 days
Levofloxacin 750 mg/tab for every 3x a
day
Exercise Practice deep breathing exercise and
coughing exercises. Resume previous
activities. Prevent extraneous work. Have
a regular physical exercise like brisk
walking for 30 minutes daily.
Treatment Ensure 500 ml
Health Teachings You should practice hand washing
regularly. Always cover the mouth and the
nose when exposed to person who coughs
or sneezes. You should not spit anywhere,
instead spit in a single container to prevent
transfer of M. Tuberculosis.
Out Patient Follow up Always have a regular check up at your
nearest health center, at least once a
week to monitor the progress of the
treatment. The client should report
immediately to the physician if there is
difficulty of breathing, there is productive
cough more than 5 days and there is chest
pain and experiencing fatigue.

Diet The diet should be high caloric. Always

drink a lot of water. Also eat fruits and
vegetables. Don’t escape meals. If there
are any food supplements available,
consult it with the doctor. Eat vitamin c rich
food to strengthen immune systems.

Spiritual/Sexual Activities Always pray for the guidance of the Lord.

Spiritual health affects the wellness of an
individual greatly. Strengthen relationship
with Lord by showing love and respect to
the people around you.