Placenta praevia

Causes
Unknown!
It is hypothesized to be related to abnormal
vascularisation of endometrium caused by
scarring or atrophy from previous trauma,
surgery (cesarean section,dilation,curettage), or
infection. These factors may reduce diferrential
growth of lower segment, resulting in less
upward shift in the placental position as
pregnancy advances.
 Grade
Grade I Placenta is in lower
segment, but the lower
edge does not reach
internal os
Lower edge of placenta
Grade II reaches internal os, but
does not cover it
Grade III Placenta covers internal
os partially
Grade IV Placenta covers internal
os completely
 Nursing management
1. Ensure the physiologic well-being of the client and
fetus
intervention :
a. Take and record vital signs, assess bleeding, and
maintain a perineal pad count. Weigh perineal pads
before and after use to estimate blood loss.
b. Observe for shock, which is characterized by a rapid
pulse, pallor, cold moist skin and a drop in blood pressure
c. Monitor the FHR
d. Enforce strict bed rest to minimize risk to the fetus
e. Observe for additional bleeding episodes.
 2. Provide client and family teaching
Intervention :
a. Explain the condition and management options. To ensure an
adequate blood supply to the mother and fetus, place the woman
at bed rest in a side-lying position. Anticipate the order for a
sonogram to localize the placenta. If the condition of mother or
fetus deteriorates, a cesarean birth will be required.
b. Prepare the client for ambulation and discharge ( may be within
48 hours of last bleeding episode)
c. Discuss the need to have transportation to the hospital available
at all times.
d. Instruct the client to return to the hospital if bleeding recurs and
to avoid intercourse until after the birth.
e. Instruct the client on proper handwashing and toileting to
prevent infection.
 3. Address emotional and
psychosocial needs
Intervention :
a. Offer emotional support to facilitate the
grieving process, if needed
b. After birth of the newborn, provide frequent
visits with the newborn so that the mother can
be certain of the infants condition
 Health teaching
Exercise
Maintain a bed rest
Maintain a 8 glasses of water
Diet (vitamin)
Late research
Abruptio Placenta
 What is abruptio placenta?
Premature separation of the normally implanted
placenta after the 20th week of pregnancy,
typically with severe hemorrhage
 2 types of abruptio placenta
Concealed hemorrhage the placenta
separation centrally and a large amount of
blood is accumulated under the placenta
External hemorrhage the separation is along
the placental margin and blood flows under
the membranes and through cervix
 Risk factor
Uterine abnormalities
Multiparity
Preeclampsia
Previous caesarean delivery
Renal or vascular disease
Trauma to the abdomen
Previous third semester bleeding
Abnormally large placenta
Short umbilical cord
Smoking, alcohol and cocaine consumption
 Nursing management
1. Continuous evaluate maternal and fetal physiologic
status, particularly:
- Vital signs
- Bleeding
- Electronic fetal and maternal monitoring tracing
- Signs of shock: rapid pulse, cold and moist skin,
decrease in blood pressure
- Decreasing urine output
- Never perform a vaginal or rectal examination or take
any action that would stimulate uterine activity
2. Assess the need for immediate delivery. If the
client is in active labor and bleeding cannot be
stopped with bed rest, emergency caesarean
delivery may be indicated
3. Provide appropriate management:
- On admission, place the woman on bed rest in a lateral
position to prevent pressure on the vena cava
- Insert a large gauge intravenous catheter into a large
vein for fluid replacement. Obtain a blood sample for
fibrinogen level
- Monitor the FHR externally and measure maternal vital
signs every 5-15 minutes. Administer oxygen to the
mother by mask
- Prepare for caesarean section, which is the method of
choice for the birth
4. Provide client and family teaching
5. Address emotional and psychosocial needs.
Outcome for the mother and fetus depends on
the extend of the separation, amount of fetal
hypoxia and amount of bleeding
 Health teaching
Educate the patient about reversible risk
factors, especially smoking before further
pregnancies
Avoid alcohol consumption and cocaine
Bed rest
 Do uterotonic drugs increase risk of
abruptio placentae and eclampsia?
Purpose:
To determine whether the use of uterotonics,
including oxytocin and prostaglandins, increases the
risk of abruptio placentae and eclampsia

Materials and methods:

A restrospective analysis was conducted among
260,174 Japanese women at term. Demographic
characteristics were studied as possible candidates
for risk factors of abruptio placentae and eclampsia
using multivariate logistic regression analyses.
Results:
A total of 1,058 (0.41%) and 147 (0.06%) women developed
abruptio placentae and eclampsia, respectively. Abruptio
placentae and eclampsia occurred in 177 (0.29%) and 42
(0.07%) of the 61,857 women treated with uterotonics,
respectively. Multivariate regression analyses indicated that
uterotonics didnt increase risk of developing either abruptio
placentae or eclampsia. Primiparity (95% confidence interval)
1.41, age >35 years 1.17 and presence of hypertension (2.42)
were significant independent risk factors for abruptio
placentae, while advancing gestation (0.67) decreased risk of
abruptio placentae. Primiparity 4.06, age <20 years (2.44),
presence of hypertension 28.7 and advancing gestation 1.28
were significant independent risk factors for eclampsia.
 Conclusion:
The use of uterotonics didnt increase the risk of
abruptio placentae and eclampsia.

Source:
Department of obstetrics and gynecology
Hokkaido University Graduate School of
Medicine, Kita-ku N15 W7, Sapporo, 060-8638,
Japan, by Morikawa M, November 29th 2013
Premature Labor

Madeline Jessica Huwae

 Definition
Premature Labor is the birth of a baby before
the developing organs are mature enough to
allow normal postnatal survival. The birth of
a baby of less than 37 weeks gestational age.
 Causes
Having a premature baby in the past.
Being pregnant with multiples (twins, triplets
or more).
Having problems with your uterus
or cervix now or in the past.
 Lifestyle Risks
Getting late or no prenatal care.
Smoking, drinking alcohol or using street
drugs.
Having a lot of stress in your life.
Little support from family and friends.
Working long hours and having to stand a lot.
Exposure to pollutants, like air pollution.
 Risk Factors
Recurring bladder and kidney infections
Urinary tract infections, vaginal infections, and
sexually transmitted infections
Infection with fever greater than 101 degrees
F during pregnancy
 Sign & Symptomps
Regular or frequent contractions a tightening
sensation in the abdomen
Constant low, dull backache
A sensation of pelvic or lower abdominal pressure
Mild abdominal cramps
Diarrhea
Vaginal spotting or bleeding
Watery vaginal discharge (water breaking) in a gush
or a trickle
A change in vaginal discharge
 Intervention
Assess the mothers condition and evaluate-signs of labor.
Obtain a thorough obstetric history
Obtain specimens for complete blood count and urinalysis
Determine frequency, duration, and intensity of uterine contractions
Determine cervical dilation and effacement
Assess status of membranes and bloody show
Evaluate the fetus for distress, size, and maturity (sonography and lecithin-
sphingomyelin ratio)
Perform measures to manage or stop preterm labor
Place the client on bed rest in the side-lying position
Prepare for possible ultrasonography, amniocentesis, tocolytic drug therapy, and steroid
theraphy
Administer tocolytic (contraction-inhibiting) medications as prescribed.
Assess for side effects of tocolytic therapy (eg, decreased maternal blood pressure, dyspnea,
chest pain, and FHR exceeding 180 beats/min)
Provide physical and emotional support. Provide adequate hydration
Provide client and family education
 Medication
Glucocorticosteroids
Tocolysis
Magnesium sulfate
 Health Teaching
Be in good health before getting pregnant
Get prenatal care as early as possible in the
pregnancy.
Eat a healthy diet.
Avoid risky substances.
Consider pregnancy spacing.
Gain weight wisely.
Family Support.