PLACENTA PREVIA

&
ABRUPTIO PLACENTA

Prepared by:
MA. CONCEPCION F. COLUMBRES, RN, RM, MN
 PLACENTA PREVIA
A condition in which the placenta is
implanted close to or covers the
cervical os.
 Normally, the placenta implants in the
upper uterine segment.
 Placenta Previa – the placenta is
implanted in an abnormal site within the
uterus, in which typically it is implanted in
the upper portion of the uterus, well away
from the cervix
 As the pregnancy progress – part of the
placenta that lies over the cervix bleeds
because of rupture of blood vessels in the
placenta.
 Cause: UNKNOWN

 The site of normal implantation is

SCARRED or DAMAGED.
 Conditions that increase the risk:

 History of elective abortion,

multiparity, advanced maternal age,
previous CS birth or uterine
incisions, maternal smoking and
prior placenta previa.
 Placentaprevia is classified according to the
degree to which the placenta covers the cervix.
 TOTAL Placenta Previa – occurs
when the placenta completely covers
the cervix.
 PARTIAL Placenta Previa – part of
the cervix is covered
 MARGINAL Placenta Previa - the
placenta does not cover the cervix
but is located on the border of the
cervix.
- the edge of the placenta
is at the margin
 Low-lying placenta- the region of the
internal os is encroached upon by the
placenta, so that the placental edge may
be palpated by the examining finger
introduced through the cervix.
ASSESSMENT

Assess for PAINLESS, BRIGHT

RED BLEEDING that begins with
no warning – strong indicator of
Placenta Previa
Bleeding may be light to severe
and usually stops spontaneously.
Bleeding occurs on an average
between 27 and 32 weeks’
gestation.
TREATMENT

 Transvaginal UTZ
 Abdominal UTZ

 CS delivery is done to save the life of the

woman and the fetus
 IV access is maintained

 2 units of blood are placed on hold for STAT

infusion.
 Serial NONSTRESS TEST (NSTs) is done to
monitor fetal well-being.
 Continuous fetal monitoring is required during
acute bleeding episodes.
INTERVENTIONS:
1. Assess vaginal bleeding every 15 min.,
then q30 min.
2. Monitor BP and V/S
3. Assess for signs of shock
4. Record intake and output
5. Do not perform vaginal examination
6. Obtain hct, hgb and Rh as needed
7. Starts IV as prescribed
8. Maintain complete bed rest
9. Assess consistency of the abdomen.
10. Assess FHT
11. Monitor external vaginal bleeding of
labor
12. If signs of fetal distress occur, turn
mother to left side, start O2 and modify
mD
 ABRUPTIO PLACENTA
 Premature separation of a normally
implanted placenta.
 Although the placenta is located in the
normal place, it pulls away from the
uterine wall before the end of labor.
 Cause: UNKNWON; however, there
are associated risk factors.
RISK FACTORS:
 Any condition that is characterized by
elevated blood pressure.
 Preeclampsia – eclampsia and pre-
existing chronic hypertension.
 Maternal age greater than 35 years and
multiparity
 Trauma ( motor vehicle collisions or
domestic violence)
 Cigarette smoking, use of cocaine
 Preterm premature rupture of the
membranes
Abruptio Placenta is classified in several ways.
Bleeding is either concealed
(hidden) or apparent, and the degree
of abruption is either partial or
complete.
If the MIDDLE PORTION of the
placenta separates but the edges
remain attached, massive hemorrhage
can occur behind the placenta but the
bleeding may remain concealed.
A small edge of the placenta may pull
away from the uterine wall and that
bleeding might be readily apparent.
 TYPES:
1. Partial abruptio placenta- small
portion of placenta separates
2. Complete abruptio placenta- total
placenta separates
3. Abruptio placenta with concealed
bleeding – blood remains with the
uterus
4. Abruptio placenta with external
bleeding- blood escapes into the
vagina
 Maternal complications:
 Hemorrhagic shock, uterine
rupture, renal failure, and death.
 If classic CS incision is done, all future
pregnancies must be delivered by CS
birth.
 Fetal complications are related to the
degree of placental separation and
maturity of the fetus.
 Hypoxia, anemia, growth
retardation and even fetal death
may occur.
 Clinical Presentation
 Diagnosis is confirmed after delivery
upon manual inspection of the placenta.
 Classic signs:

 PAIN – sudden onset and is constant

 DARK RED VAGINAL BLEEDING –
is apparent in most cases
 TENDER ABDOMEN that is rigid to
palpation, and
 HYPERTONIC LABOR.
Uterus may not relax well
between contractions
Amniotic fluid often is bloody,
Signs of maternal shock and
fetal distress may be present.
Fundal height may increase
with severe intrauterine
bleeding.
Ultrasound may assist with
the dx.
 INTERVENTIONS:

A. Improving tissue perfusion:

1. Evaluate the amount of bleeding/control
hemorrhage
2. Position on the left lateral position, with
elevated head of bed, maintain on side lying
position to avoid pressure in the vena cava
3. Administer oxygen through the face mask
4. Establish an IV line, do blood transfusion as
prescribed
5. Evaluate the fetal status with external fetal
monitoring
6. Encourage relaxation technique

B. Ensuring fluid volume

1. Establish and maintain IV line
2. Evaluate coagulation studies
3. Monitor v/s
4. Monitor vaginal bleeding
C. Prevent infections;
1. Use aseptic technique when doing
invasive procedure
D. Relieving pain and anxiety
1. Explain all procedure to patient.
Include the benefit to the women and her
fetus.
2. Encourage the presence of support
person
3. Encourage expression of feelings
Postpartum:
1. Be alert for uterine atony,
hemorrhage, puerperal infection
2. Monitor urinary output or
hematuria from renal failure
3. Observe for pulmonary emboli