JOURNAL INFORMATION:

Research Article | Open Access

Volume 2017 |Article ID 8318751 | https://doi.org/10.1155/2017/8318751

Maternal Morbidity in Women with Placenta Previa Managed with Prediction of Morbidly
Adherent Placenta by Ultrasonography

Midori Fujisaki,1 Seishi Furukawa,2 Yohei Maki,1 Masanao Oohashi,1 Koutarou Doi,1 and Hiroshi

Sameshima1

Academic Editor: Albert Fortuny

Received16 Nov 2016

Revised19 Mar 2017

Accepted03 Apr 2017

Published24 Apr 2017

Abstract

Objective. To determine maternal morbidity in women with placenta previa managed with prediction of
morbidly adherent placenta (MAP) by ultrasonography. Methods. A retrospective cohort study was
undertaken comprising forty-one women who had placenta previa with or without risk factors for MAP.
Women who had all three findings (bladder line interruption, placental lacunae, and absence of the
retroplacental clear zone) were regarded as high suspicion for MAP and underwent cesarean section
followed by hysterectomy. We attempted placental removal for women having two findings or
less. Results. Among 28 women with risk, nine with high suspicion underwent hysterectomy and were
diagnosed with MAP. Three of 19 women with two findings or less eventually underwent hysterectomy
and were diagnosed with MAP. The sensitivity and positive predictive value for the detection of MAP
were 64% and 100%. The pathological severity of MAP was significantly correlated with the cumulative
number of findings. There were no cases of MAP among 13 women without risk. There was no difference
of blood loss between women with high suspicion and those without risk ( ml versus  ml,
resp.; ). Conclusion. Management with prediction of MAP by ultrasonography is useful for obtaining
permissible morbidity.
BIBLIOGRAPHY:

BOOK REFERENCE:

 Annamma Jacob A. A comprehensive textbook of midwifery. Second edition. India; Jaypee

Brothers Medical publishers (P) ltd.

 Cunningham, Leveno, Bloom. (2010)William’s obstetrics. 23rd edition. United states of America;
Mcgraw Hill companies

 Dutta D.C. (2004),Textbook of obstetrics. Sixth edition. Calcutta, India; New Central Book
agency (P) Ltd

 Fraser DM, Cooper MA. Myles(2003) Textbook of Midwives. Fourteenth edition. Edinburgh;
Churchill Livingstone.

  Perry, Hockenberry, Lowdermilk et al. Maternal Child Nursing Care. 5th edition;Elsevier
publicaton

 Renu mishra.IAN DONALD’S Practical Obstetric problems.. 7th edition ; Wolters kluwer
publication.

 Pillitteri A. Maternal and child health nursing. Care of the childbearing and childrearing family.
Sixth edition. Philadelphia; Lippincott Williams & wilkins: 2010.

JOURNAL REFERENCE:

Midori Fujisaki,1 Seishi Furukawa,2 Yohei Maki,1 Masanao Oohashi,1 Koutarou

Doi,1 and Hiroshi Sameshima1 Maternal Morbidity in Women with Placenta Previa Managed with
Prediction of Morbidly Adherent Placenta by Ultrasonography Volume 2017 |Article
ID 8318751 | https://doi.org/10.1155/2017/8318751

NETREFERENCE:

1. https://www.ncbi.nlm.nih.gov/pmc/articles

2. https://www.slideshare.net

3. https://www.scribd.com
COMPLICATIONS OF PLACENTA PRAEVIA:

(A) Maternal: •Maternal mortality rate is 0.2%.

a. During pregnancy: b.During labour:

1. abortion Premature rupture of membranes.

2. Preterm labour Cord prolapse.
3. aph Inertia.
4. Mal presentation Obstructed labour.
5. Non engagement Postpartum haemorrhage.
Retained placenta.
Placenta accreta
Lacerations of lower uterine segment
Air embolism due to low placental site.

(B) Foetal
Foetal mortality rate is 20%.
1.Prematurity.
2.Asphyxia.
3.Malformations (2%)..
NURSING MANAGEMENT

1. If continuation of the pregnancy is deemed safe for patient and fetus administer magnesium sulfate as
ordered for premature labor

2. Obtain blood samples for complete blood count and blood type and cross matching

3. Institute complete bed rest

4. If the patient and placenta previa is experiencing active bleeding, continuously monitor her blood
pressure, pulse rate, respiration, central venous pressure, intake and output, and amount of vaginal
bleeding as well as the fetal heart rate and rhythm

5. Assist with application of intermittent or continuous electronic fetal monitoring as indicated by

maternal and fetal status.

6. Have oxygen readily available for use should fetal distress occur, as indicated by bradycardia,
tachycardia, late or available decelerations, pathologic sinusoidal pattern,

unstable baseline, or loss of variability.

7. If the patient is Rh-negative and not sensitized, administer Rh (D) immune globulin (RhoGAM) after
every bleeding episode.8. Administer prescribed IV fluids and blood products.

9. Provide information about labor progress and the condition of the fetus.

10. Prepare the patient and her family for a possible caesarian delivery and the birth of a preterm neonate,
and provide thorough instructions for postpartum care.

11. If the fetus less than 36 weeks gestation expect to administer an initial dose of betamethasone: explain
that additional doses may be given again in 24 hours and possibly

for the next 2 weeks to help mature the neonates lungs.

12. Explain that the fetus survival depends on gestational age and amount of maternal blood loss. Request
consultation with a neontologist or pediatrician to discuss a treatment plan

with the patient and her family.

13. Assure the patient that frequent monitoring and prompt management greatly reduce the risk of
neonatal death.

14. Encourage the patient and her family to verbalize their feelings helps them to develop effective
coping strategies, and refer them for counseling, if necessary.

15. Anticipate the need for a referral for home care if the patient bleeding ceases and she’s to return
home in bed rest.

16. During the postpartum period, monitor the patient for signs of early and late postpartum hemorrhage
and shock.
17. Monitor VS for elevated temperature, pulse, and blood pressure, monitor laboratory results for
elevated WBC count, differential shift; check for urine tenderness and

malodorous vaginal discharge to detect early signs of infection resulting from exposure of placental
tissue.

18. Provide or teach perineal hygiene to decrease the risk of ascending infection.

19. Observe for abnormal fetal heart rate patterns such as loss of variability, decelerations tachycardia to
identify fetal distress.

20. Position the patient in side lying position and wedge for support to maximize placental perfusion.

21. Assess fetal movement to evaluate for possible fetal hypoxia.

22. Teach woman to monitor fetal movement to evaluate well being

23. Administer oxygen as ordered to increase oxygenation to mother and fetus.