1. Definition :
Placenta:
The placenta is an organ that develops in uterus
during pregnancy. This structure provides oxygen
and nutrients to growing baby and removes waste
products from baby's blood. The placenta attaches
to the wall of uterus, and baby's umbilical cord
arises from it. The organ is usually attached to the
top, side, front or back of the uterus.
3. Objective
*At the end of this seminar we will able to Identify :
- Definetion
- Pathophysiology .
- Classification.
- Causes , risk factors and complication
-Signs and symptoms .
- Laboratory and Diagnostic Testing
-Nursing Assessment and Nursing medical
management .
- Pt education .
6. Abruption Placenta
Placental abruption occurs when the placenta
partly or completely separates from the inner
wall of the uterus before delivery. This can
decrease or block the baby's supply of oxygen
and nutrients and cause heavy dark
bleeding in the mother.
It can occur at any time after 20 weeks of
pregnancy, but it’s most common in the third
trimester.
7. the abruption start with degenerative change in the
small maternal arterioles , resulting in : thrombosis
,, and possible rupture of a vessels .
Bleeding from the vessels forms a retroplacental clot .
The bleeding causes increase pressure behind the
placenta and result in separation .
Pathophysiology
8. • Mild (grade 1): minimal bleeding
(less than 500 mL), marginal
separation (10% to 20%), tender
uterus, no coagulopathy, no signs of
shock, no fetal distress
• Moderate (grade 2): moderate
bleeding (1,000 to 1,500 mL),
moderate separation (20% to 50%),
continuous abdominal pain, mild
shock, normal maternal blood
pressure , maternal tachycardia .
• Severe (grade 3):absent to moderate
bleeding (more than 1,500 ml), sever
separetion(more than 50%), profound
shock , dark vaginal bleeding , sever
abdominal pain , decreased maternal
blood pressure tachycardia and
development of dissminated
intervascular coagulopathy (DIC).
Abruptio
placentae is
classified to
the : 1. extent
of separation
2. the amount
of blood loss
from maternal
circulation
includs :
13. maternal :
- sever hemorrage
- need for blood transfusion
- emergency hysterectomy
Complication
14. Fetal :
- low birth weigh .
- preterm delivery .
-Decreased oxygen to the baby, which could lead
to brain damage
- stillbirth .
Complication
15. Medical history
Physical examination, including checking
the tenderness and tone of the uterus
CBC
Fibrinogen levels—typically are increased
in pregnancy
(PT) , (PTT)
ultrasound
CT scan is more reliable method for
evaluation of placenta abruption .
Laboratory and
diagnostic testing :
16. Begin the health history by assessing the woman for
risk factors that may predispose her to abruption
placenta .
Assessing the pregnant woman presenting with
abdominal pain
The vaginal area is inspected for the presence
of bleeding.
Nursing Assessment
17. palpation of the uterus for tenderness, consistency, and
frequency and duration of uterine contractions
auscultation of fetal heart sounds and ask about fetal
movement, recent changes in activity patterns
.
18. Nursing Management
Obtain maternal vital signs frequently ,even 15 min .
Monitor the amount and characteristics of any
vaginal bleeding as frequently as every 15 to 30
minutes.
Communicate empathy and understanding of the
client’s experience, and provide emotional support.
19. Medical management
To avoid a worsening condition, these medical
procedures are implemented for both the mother
and the fetus :
1- Intravenous therapy : Once the woman starts
to bleed, the physician would order a large gauge
catheter to replace the fluid losses.
2- Oxygen inhalation: Delivered via face mask,
this would prevent fetal anoxia.
3- Fibrinogen determination: This test would be
taken several times before birth to detect DIC.
20. If you’re less than 34 weeks pregnant: You might have be
admitted into the hospital for monitoring -- as long as
baby’s heart rate is normal and the placental abruption
doesn’t seem to be severe. If baby appears to be doing fine
and stop bleeding in mother , you eventually might be able
to go home. You might also be given steroids to help baby’s
lungs develop faster in case you do go into labor early.
If you’re more than 34 weeks pregnant: if the abruption
does seem severe. If it is, and it’s putting health or baby’s
health at risk, you’ll need a C-section right away. You
might also need a blood transfusion.
21. Health education
*urge her to seek early
and continuose prenatal
care and receive promot
health care if any signs
and symptoms occure in
future pregnancies .
*encourage the women
to avoid smoking ,or
using drugs during
pregnancy.
22. Nursing care plane
planning
Evaluation
Rationale
Nursing
Interventions
Nursing
Diagnosis
Goal : client
will be relief or
control of
pain .
Outcome :
Patient will
report relief or
control of pain.
.
- The patient
will be able to
feel
comfortable
and verrbalize
reduce of pain .
To help
determine the
possibility of
underlying
condition or
organ
dysfunction
requiring
treatment.
To maintain
an acceptable
level of pain.
To promote
non
pharmacologi
cal pain
management.
-Assess for
referred pain as
appropriate.
-Administer
analgesics as
indicated.
-Provide
comfort
measures, quiet
environment,
and calm
activities.
Acute Pain
RT
Sudden
separation of
placenta AMB
Sharp,
stabbing pain
high in the
uterine fundus
Uterine
tenderness
24. Definition :
Placenta Previa :
when a pregnant woman's placenta blocks the
opening to the cervix that allows the baby to be
born. It can cause severe bleeding(Bright red)
during pregnancy and delivery
. Partial previa: The placenta covers part of the
cervical opening.
Complete previa: The placenta covers the entire
cervical opening.
25. Type of placenta previa
Marginal: The placenta is next to the cervix but
does not cover the opening.
. Partial previa: The placenta covers part of the cervical
opening.
Complete previa: The placenta covers the entire cervical
opening.
26. * The exact cause of placenta previa is unknown
• It is initiated by implantation of the embryo in the
lowor uterus may be due to :
* damage in the upper segment
• Uterine endometrial scarring
• Which may incite placental growth in the
unscarred lower uterine segment ,with placenta
attachment and growth ,the cervical become
coverd by developing placenta
Pathophysiology
27. Risk factors
Maternal age ( more than 35 years ) .
Smoking .
Previous C/S birth .
Uterine injury .
Multiple gestations .
Previous induced surgical abortion .
28. Signs and symptoms
Vaginal bleeding without pain
. Contraction along with the
bleeding
29. Complication
maternal :
bleeding after delivery .
Emergency caesarean delivery
Shock from loss of blood
Fetal :
Fetal distress from lack of oxygen
31. Nursing
Assessment
Rapid assessment is essential to ensure prompt,
effective interventions to prevent maternal and
fetal morbidity and mortality.
Monitor vital signs
Monitor fetal HR
Blood transfusion for the mother.
32. Medical management
Depends on :
the exent of bleeding :
If it's light, your doctor might suggest you avoid activities
including exercise. If it's heavy, you may need to go to
the emergency room.
Whether the placenta previa is complete or
partial
The exact location of the placenta
The gestational age of the baby
The position of the baby
The health of the baby
33. * Rest at home
* Discharge plan
* CTG ( fetal HR )
Contraction
* dexamethazone
If the amount of
bleeding is small :
If the amount of bleeding is
large :
Management :
Blood transfusion for the
mother.
Delivary C/S
34. Health education
Encourage the women to avoid smoking ,or
using drugs during pregnancy.
Do not do any heavy activity .
35. Nursing Diagnosis Nursing
Interventions
Rationale
Deficient fluid volume
related to active blood loss
secondary to placenta
previa
*Monitor Vital Signs
*Assess color, odor,
consistency and amount of
vaginal bleeding
*Assess hourly intake and
output.
*To obtain baseline data
*To assess degree of blood
loss
Provides information about
maternal and fetal
physiologic compensation to
blood loss
Outcome : The
patient will re-
establish a
functional body
fluid volume and
balanced input
and output status .
37. Placenta
abruption
Placenta previa
manifestation
Sudden
insdious
Onset
Can be concealed or visible
Always visible ,slight, then
more profuse
Type of bleeding
dark
Bright red
Blood description
Constant, uterine
tenderness on palpation
None (painless)
Discomfort / pain
Firm to rigid
Soft and relaxed
Uterine tone
Fetal distress or absent
Usually in normal rang
Fetal heart rate
