Predisposing Factors

Precipitating Factors

Advanced
Increased Past CS Past uterine Multiple
Maternal Smoking Cocaine Use
Parity Birth curretage Gestation
Age (>35)

Susceptible Scarring of Inhalation of

Scarring of Additional carbon Ability to
Endometrial for the uterine
the uterine pressure to monoxide cross the
Scarring physiologic lining
tissues the uterus placenta
complications (endometrium)

Decreased
Trophoblastic Decrease
Low Defective oxygen
Invasion blood Impaired
functionality vascularization supply of
into the supply to functionality
of placenta of the blood in the Disrupts
lower the and ability
endometrium bloodstream fetal CNS
uterine endometrial
segment lining

Inability to Uterine Intereferes

provide scars with the
adequate provide an Abnormal Emergency quality and Impaired
nutrients environment vascularization response of quantity of development
and oxygen feasible for on the placenta oxygen and inhibit
to the fetus growth endometrium supply in blood flow
(oxygen and the placenta in the brain
collagen)
Elongation
of placenta
Placenta will (severe Placenta will
compensate Adherance cases: compensate
of completely to provide
trophoblast covers the needs of
to the vaginal the fetus
uterine scar opening)
Elongation
and growth
in size of
Elongation
placenta
Placenta and increase
covering the in surface
cervical OS area of
placenta

PLACENTA PREVIA: Implantation of the Embryo

(Embryonic plate) in the lower (caudad) Uterus.

Total Placenta Previa Partial Placenta Previa Marginal placenta previa Low Lying placenta previa

implantation that occludes the placenta edge Implantation in the lower

Implantation that totally
a portion of the cervical approaches that of the rather than in the upper
obstructs the cervical os
os cervical os portion of the uterus

Approximately
30 weeks

Differentiation of Cervical
lower uterine Dilation
segment from
upper segment

Placenta is unable to
stretch to accomodate
the differing shape of
the lower uterine
segment

SIGNS AND SYMPTOMS

Small Painless Relaxed soft Mild to profuse Abnormal

Visible
portion of bright red uterus episodes of fetal
Bleeding
placenta bleeding non-tender bleeding (3rd position
loosens trimester)

No
contractions No Placenta Low
Bleeding of contractions located in implantation
damaged of the uterus Body is the cervical of placenta
blood preparing OS
vessels Bleeding of for delivery
the
damaged
Upon Inaccurate
blood
bleeding, positioning
vessels
blood will of tthe
trickle down placenta
Cervical
the vaginal
Placenta Effacement
opening
located in
the lower
uterine Baby
segment compensate
(endometrium) Damaged by attaining
blood a
vessels of comfortable
the placenta position

IMAGING
LABORATORY
AND OTHER
WORK UPS
STUDIES

To obtain an accurate diagnosis

of placenta previa. This imaging Presence of echolucent Speculum
RH Transvaginal or circular lines overlying
Magnetic External
FSP and Blood modality is accurate, Resonance Fetal Examination
Compatability PT and aPTT CBC Other Tests cost-effective, and well tolerated. the internal os. Should
Fibrinogen Typing if Necessary Imaging Monitoring (minimum
Test alert the examiner to the
presence of vasa previa. previa)
This can be confirmed by
transvaginal assessment
Ultrasonography with color and spectral
A group of (Sonogram) Doppler, confirming Used for Used to
Can also be used as an
To detect any tests that Amniocentesis presence of arterial fetal planning the To record and determine the
To measures To measure Apt or Fetal lung alternative to TVS; however, it is
RH To measures Activity test To determine evaluate the and Fetal Transabdominal less accurate, with the vessels. delivery in have an degree of fetal
the time it and evaluates Klelhauer-BetKe maturity
incompatibility the level of that evaluates the blood cells that Lung false-positive and false-negative that it may accurate data enagagement
FDPs to see if takes for the all the clotting Test amniocentesis
between the part of the type of circulate in Maturity rates help identify on FHR and detect
there is a liquid portion factors of the can determine
mother and clotting mother and blood, Testing placenta other causes of
clotting of the blood to intrinsic and whether a
fetus process in the fetus including red accreta, bleeding
disorder clot. This common baby's lungs
which soluble blood cells Suggested as another alternative
liquid portion pathways of are ready for Evaluation of placenta (ruptured
fibrinogen is (RBCs), white Detect any to transvaginal ultrasonography,
of the blood is the clotting birth. This the fetus is Will usually show the internal increta, or varices/cervical
converted into blood cells cases of At 36 to 37 especially when instrumentation surface of the cervix without
called cascade by type of valuable in Transperineal/ placenta Normal FHR: trauma)
To be ready fibrin threads (WBCs), and excessive of the vaginal canal with a probe overlying placental tissue,
Normal: plasma. measuring the weeks, the amniocentesis Ul Translabial percreta. 130-160bpm
for any blood platelets fetomaternal provider may
identifying is a concern. However, it is often allowing confident exclusion
First Clotting refers time To be ready is done only if
replacement (PLTs) hemorrhage current deferred to the accuracy, safety of placenta previa.
to the for blood suggest an early delivery
Trimester: (>30 mL) that gestational age and tolerability of transvaginal
upon delivery Normal: formation of transfusion amniocentesis either through ultrasonography.
0.05?0.95 would
First the blood and upon to test the induction or and weight,
Second necessitate
Trimester: proteins into a Normal: emergency amniotic fluid C-section is potential
Trimester: additional
244?510 solid mass to First Normal WBCs: around the being congenital
0.32?1.29 Normal RBCs: Rh-immune
Second stop bleeding Trimester: baby to see if considered to anomalies,
Third First Trimester: First globulin therapy
Trimester: 24.3 to 38.9 the lungs are prevent
Trimester: 3.42?4.55 Trimester: malpresentation,
291?538 secs. fully pregnancy
0.13?1.7 Second 5.7?13.6 and evidence
Third Second developed. complications
(mg/mL) Trimester: Second for fetal growth
Trimester: Trimester: 2.81?4.49 Trimester: for the mother
373?619 Normal: 12.60 to 24.2 to 38.1 To detect in a restriction.
Third Trimester: 5.6?14.8
(mg/dL) 13.26 seconds for secs. whether the nonemergency
2.71?4.43 Third Normal:
healthy pregnant Third blood is situation
Trimester: 1. No genetic or
patients less than Trimester: 5.9?16.9 maternal or
20 years of age. chromosome
24.7 to 35.0 fetal origin
12.81 to 13.52 problems were
secs.
seconds for found in the
healthy pregnant Normal baby.
patients over 20 PLTs: 2. Bilirubin and
years of age. First alpha-fetoprotein
Trimester: levels appear
174?391 normal.
Second 3. No signs of
Trimester: infection were
155?409 found.
Third
A disseminated intravascular coagulopathy (DIC) profile with
Trimester:
prothrombin time (PT), activated partial thromboplastin time
146?429
(aPTT), fibrinogen, and fibrin split products (FSP) also may be
helpful because retroplacental bleeding has been associated with
consumptive coagulopathy.

IF TREATED IF UNTREATED
Signs and Symptoms

Maternal Complication Abnormal

Medical Nursing Profuse Lower
vaginal
Management Management Swelling vaginal abdominal Fever
discharge
bleeding pain
(Yellow-Green)
Drug Therapy: Surgical Travel of Damaged Fetal Complication
Management: normal uterine
corticosteroids Placental site in the Rupture of Endometritis
bacterial tissue
(Bethamethasone) lower uterine segment amniotic sac Invasion of Inflammation
Cesarean INDEPENDENT COLLABORATIVE flora from during CS
pathogens Inflammation Body
Section the cervix delivery of the
R: Corticosteroids since Invasion of of the attempts to
and vagina uterine
hastens fetal lung placenta is pathogen uterine fight off
R: CS delivery is lining Deprivation of Blood and
maturity for near the lining infection
usually required Place the woman on Nutrients
babies delivered to prevent the bed-rest in a cervical OS
prematurely or Physicians:
risk of severe left-side lying To have an
less than 34 bleeding during position Ineffective Immune
weeks accurate assess
vaginal delivery. contraction Ineffective system's
and diagnosis, Infection
R: To avoid excess and prescibe uterine Sign of normal
blood loss and occurs contractions infection emergency Placental insufficiency Signs and Symptoms
medications and
ensure an adequate other therapeutic response to
blood supply. regimens (blood pathogens Erratic or
IV Fluids Poor Fetal Difficulty
transfusion, etc) Cyanosis irregular
Movement breathing
to ensure the Inflammation heart rate.
R: To Inspect Intrauterine Growth
safety of both Profuse Bleeding of uterine Fetal Hypoxia
facilitate perineum for Restriction
mother and the lining
hydraton to bleeding and fetus
the patient assess for rate Response t he fetus is low oxygen Oxgen
incase of blood loss with the fall deprived of levels in supply does
excessive Signs and Symptoms in fetal an adequate your body's not meet
blood loss R: To have an oxygen supply of tissues demand by
Postpartum Hemorrhage Congenital Fetal Distress
accurate data Small for consumption oxygen. the fetus
OB-Gyne: Gestational Age Anomallies
on the To perform Pale or Shortness of Irregular
patient's blood Fatigue Headaches
sonogram to yellowish skin breath Heartbeat decrease the
loss and assess the Under cost of Heart will try
provide fetal's -oxygenated breathing to to
necessary FETAL DEATH blood is bluer avoid too compensate
well-being Decreased Blood Volume Decrease RBC
emergency and and causes much the needs of
Signs and Symptoms Lack Lack of Body does Low levels The heart
measures to speculum your skin to oxygen the fetus
enough hemoglobin not get of pumps more
prevent look bluish utilization
examination healthy red in red blood enough hemoglobin blood to
hypovolemic Cold and purple.
(if needed) blood cells cells oxygen-rich prevent
shock. Clammy Tachycardia Dyspnea Hypotension make up for
to carry blood. adequate the lack of
Skin
Hypovolemic shock Anemia adequate oxygen from oxygen in
Surgeon: oxygen to reaching the the blood.
To perfrom As the
Obtain your body's the lungs brain.
cesarean loss of tissues numbers of
baseline The body over-
section effective Severe Blood Reduction in red blood
vital signs compensates compensate
Loss circulating cells
delivery circulating for volume in order to
blood volume blood volume become
R: To loss by DEATH bring in
increasing Less oxygen restricted,
determmine not enough more
Medical heart rate reaches
whether reach the oxygen
Technologist: Decrease in your tissues
hypoveolemic As the body Decreased surface of
To obtain central and
shock are attempts to level of red the skin.
accurate venous muscles,
present. preserve blood cells
information pressure depriving
on oxygen them of
delivery to the energy
laboratory
brain and
Frequent tests Oxygen in the
heart blood is
fetal requiring blood are Reduced
shunted away
monitoring blood lowerthan cardiac output
from
samples normal.
extremities
R: To assess and nonvital
the fetal's organs
well-being

Monitor
urine output

R: To assess
if the
patient's
blood
volume is
adequate to
perfuse the
kidneys.

Prepare
oxygen
equipment

R: Used in Poor
case the Prognosis
fetus shows
signs of
fetal
distress.

Good
Prognosis