Presentation of preclampsia

1. NMT 05209: PRE-REFERRAL MANAGEMENT OF
WOMAN WITH PLACENTA PRAEVIA AND
ABRUPTIO PLACENTA
SESSION 5
BY GREGORY KALINGA

2. Objectives
At the end of this session a learner is expected to be able
to:
–Define placenta previa and abruptio placenta
–Outline Predisposing factors of placenta praevia
–Outline risk factors of abruptio placenta
–Identify signs and symptoms of placenta praevia and
abruptio placenta
–Give pre-referral care of a woman with placenta praevia
and abruptio placenta

3. Definition of Placenta previa and Abruptio placenta
• Placenta previa is the implantation of the placenta in the
lower uterine segment, it may be near or at the cervix
–Normally, the placenta attaches toward the top of the
uterus, away from the cervix.
–Placenta previa can cause severe bleeding during
pregnancy and delivery.

4. Cnt..
Abruptio placenta
is premature detachment of a placenta normally
implanted placenta from the uterus before delivery of the
foetus

5. Cnt..
Placenta previa

6. Predisposing Factors of placenta previa
• An infection or inflammation of the fallopian tube can
cause it to become partially or entirely blocked.
• Scar tissue from a previous infection or a surgical
procedure on the tube may also impede the
egg’s movement.
• Previous surgery in the pelvic area or on the tubes can
cause adhesions.
• Abnormal growths or a birth defect can result in an
abnormality in the tube’s shape.

7. Risk Factors for Abruptio Placenta
• Previous abruptio placenta
• Pre-eclampsia
• Sudden emptying of the uterus as in rupture of
membranes in polyhydramnios
• Direct trauma to the uterus

8. Signs and symptoms of Placenta Previa
–Painless unprovoked vaginal bleeding of variable
amounts,
–Normal foetal movements.
–Shock depending on blood loss
–Non-tender, soft uterus,
– mal-presentation
–High presenting part

9. Cnt..
• Foetal heart tones normal
• Foetal distress if blood loss is severe
• Bright red bleeding from the genitalia.

10. Signs and symptoms of Abrutio Placenta
• Painful vaginal bleeding
• Loss of foetal movement
• Dark-coloured blood from the vagina with clots, dizziness,
fainting attacks.
• Variable degree of shock, which may not correspond to
the visible blood loss
• Anaemia
• Uterus greater than dates

11. Cnt..
• Hypertonic contraction
• Hard and tender uterus.
• Foetal heart beats usually absent and foetal parts are not
easily palpable.
• Cervix may be dilated or closed.
• Blood-stained liquor—if membranes have ruptured.

12. Pre-referral Management of
Placenta Previa and Abruptio
Placenta

13. Pre-referral Management of Placenta Previa
• Shout for help and urgently mobilize staff available
• Resuscitation with intravenous fluids, Ringer’s lactate or
normal saline 3 liters, or more to stabilise the patient if
bleeding is severe
• Make a rapid evaluation of her condition.
• Refer to hospital.
• A health care provider should escort the patient.
• Avoid digital vaginal examination.

14. Pre-referral management of abruptio placenta
• Shout for help. Urgently mobilize staff available.
• Begin resuscitation with intravenous fluids (Ringer’s
lactate or Normal Saline) 3 litres or more to stabilise the
patient.
• Make a rapid evaluation of her condition.
• Give diclofenac 75mg i.m stat and insert an indwelling
urethral catheter.

15. Cnt..
• Refer to hospital if delivery is not imminent.
• A health care provider should escort the patient.
• Note: Risk for postpartum bleeding and disseminated
intravascular coagulopathy

16. Summary
• Placenta previa is the implantation of the placenta in the
lower uterine segment, it may be near or at the cervix.
• Abruptio placenta is premature detachment of a normally
implanted placenta from the uterus before delivery of the
foetus.
• Predisposing factors of placenta previa includes infection
or inflammation of the fallopian tube, scar tissue from
previous infection, previous surgery in the pelvic area and
abnormal growth or birth defect

17. Cnt..
• Risk factors for includes; previous abruptio placenta, pre-
eclampsia, sudden emptying of the uterus as in rupture of
membranes in polyhydramnios and direct trauma to the
uterus
• Refer to hospital if delivery of pregnant woman with
placenta previa and abruptio placenta is not imminent.
• A health care provider should escort the patient(s).

18. Refferences
• MoHSW (2008). Emergency obstetric care job aid. .
• MoHSW (2013). Malaria Diagnosis and Treatment
Training Manual.
• MoHSW. (2005). Advanced Life Saving Skills Volume 2
Training Manual.
• MoHSW (2007). Tanzania National PMTCT Guidelines.

19. Cnt
• Ruth. V.B. & Linda .K.B.(1996). Myles Textbook for
Midwives, (12th Ed) Churchill Livingstone Edinburg
London Madrid Melbourne New York and Tokyo
• WHO Family planning (2011). A Global Handbook for
Providers. United States Agency for International
Development USAIDS.