Placenta Previa

 The placenta implants in the lower uterine segment, near the cervical os. The most common
cause of painless bleeding in the 3rd trimester of pregnancy. Incidence is 5 per 1000
pregnancies.

3 different classifications

1. Total placenta previa - occurs when the placenta completely covers the internal os.

2. Partial placenta previa - occurs when the placenta partially covers the internal os.

3. Low-lying or low-implantation placenta previa - occurs when the placental border

reaches the border of the internal os.

Predisposing factors:

 Multiparity  Multiple gestation  Uterine incisions

 Advanced maternal  Previous cesarean  Previous placenta
age birth previa

Clinical Manifestations

 Bright red, painless vaginal bleeding

 Soft, nontender abdomen; relaxes between contractions, if present.
 FHR stable and within normal limits.

Diagnostic Procedure ------------- Transabdominal ultrasonography

Nursing Management

 Ensure the physiologic well-being of the client and fetus.

 Provide client and family teaching.
 Address emotional and psychosocial needs.
Abruptio Placenta

 Is a premature separation of normally implanted placenta after the 20th week of pregnancy,
typically with severe hemorrhage. Occurs in 10 out of 1,000 pregnancies.

Risk factors:

 Uterine anomalies  Abnormally large placenta

 Multiparity  Short umbilical cord
 Preeclampsia  Cocaine or cigarette use
 Previous cesarean delivery  Thrombophilic conditions
 Renal or vascular disease  Chorioamnionitis
 Trauma to the abdomen  Rapid decrease in uterine volume
 Previous third trimester bleeding
Clinical Manifestations

 Intense, localized uterine pain, with or without vaginal bleeding

 Concealed or external dark red bleeding.
 Uterus firm to boardlike, with severe continuous pain.
 Uterine contractions. Uterine outline possibly enlarged or changing shape.
 FHR present or absent. Fetal presenting part may be engaged.

Nursing management

 Continuously evaluate maternal and fetal physiologic status.

 Assess the need for immediate delivery.
 Provide appropriate management.
 Provide client and family teaching.
 Address emotional and psychosocial needs.
Anemia

 Hemoglobin value of less than 11mg/dL or hematocrit value less than 33% during the second
and third trimesters.
 Mild anemia (hemoglobin value of 11 mg/dL) poses no threat but is an indication of a less than
optimal nutritional state.
 Iron deficiency anemia is the most common anemia of pregnancy.

Causes:

 Nutritional deficiency  Acute and chronic  Hemolysis

blood loss

Clinical Manifestations

 brittle fingernails cheilosis

 smooth, red, shiny tongue
 Women with sickle cell anemia experience painful crisis episodes

Nursing Management

 Provide client and family teaching (Iron supplements and dietary sources of iron as indicated)
 Prepare for blood-typing and crossmatching, and for dministering packed RBCs during labor if
the client has severe anemia.
 Provide support and management for clients with hemoglobinopathies.