3. â•The patient
E, weight 74 kg.
is y/o,
She is conscious, coherent
-£•With the following Vital Signs:
BP= 120/80 mmHg
PR 72 bpm
RR 23 /cpm
Temp 36.8°C
21. C/O: Mfid Hypogastric Pain
N£EDICAL HISTORY: G9P7A1 29 3/7
weeks Age of Gestation
ON EXAMINATION: BP:
12o/g0mmHg, PR: 72 bpm, RR: 23 cpm,
Temp. 36.80C
• LMP: Unknown
• PV not done
• No allergies to any food or drug
• With Hypertensive and Diabetic parents
22. Tab. NIFEDIPINE
DEXAMETHASONE
10mg T!D x 48
hours PO
6mg every 6
hours for 3
doses IV
•Decreases arterial smooth
muscle contractility and
subsequent
vasoconstriction
•A synthetic glucocorticoid
which decreases
inflammation by inhibiting
the migration of leukocytes
and reversal of increased
capillary permeability
23. AGIOLAX
Tab.
FERROUS
SULFATE
2tsp BID PO
I tab OD PO
•SuitabIe for bowel
regulation during
pregnancy and post
partum
'Provides supplemental
iron, an essential
component in the
formation of hemoglobin
26. t•Gtrasooographic Result
—PU 3lweeks + 5days AOG by fetal
biometry
—Live Singleton in cephalic presentation,
Male fems
—L
e
0 Lateral Placenta, Grade II, Previa
Totalis
—Adequate Guid volume
BPP= 8/8
27.
28. • MRI Result:
Pelvis shows gravid uterus with single fetus and
the placenta is in left lateral position and in lower
uterine segment completely covering the internal
os and shows heterogenous sigal intensity with
bulging of lower uterine segment and irregular
thick intraplacental T2 dark bands and loss of thin
subplacental myometrial zone and tenting of the
urinary bladder seen along its ntero-superior
margin, most probably suggestive of placenta
previa.
29. •t• The term placenta previa refers to a placenta that overlies or is
proximate to the internal os of the cervix. The placenta normally
implants in the upper uterine segment. In placenta previa, the
placenta either totally or partially lies within the lower uterine
segment. Traditionally, placenta previa has been categorized
intO 4 types:
1. Complete placenta previa
o where the placenta cOmpletely covers the internal os.
2. Partial placenta previa
o where the placenta partially covers the internal os. Thus, this
scenario happens only when the internal os is dilated to some
degree.
3. Marginal placenta previa
o which just reaches the internal os, but does not cover it.
4. Low lying placenta
o which extends intO the lower uterine segment but does not
reach the internal os.
30.
31.
32. The placenta signifies the "second" or "embryonic" period
of pregnancy (after the implantation period) and
describes the establishment of a fully functional placenta.
The placenta is an apposition of foetal and parental tissue
for the purposes of physiological exchange. There is little
mixing of maternal and foetal blood, and for most
purposes the two can be considered as separate.
The placenta can be thought of as a "symbiotic parasite",
unique to mammalia. The placenta provides an interface
for the exchange of gases, food and waste. It also
facilitates the de novo production of fuel substrates and
hormones and filters potentially toxic substances.
The placenta has two distinct seperate compartments; the
fetal side consisting of the trophoblast and chorionic villi
and the maternal side consisting of the decidua basalis.
33. The placenta consists of a foetal portion formed by
the chorion and a maternal portion formed by the
decidua basalis. The uteroplacental circulatory
system begins to develop from approximately day 9
via the formation of vascular spaces called
"trophoblastic lacunae".
Maternal sinusoids develop from capillaries of the
maternal side which anastamose with these
trophoblastic lacunae. The differential pressure
between the arterial and venous channels that
communicate with the lacunae establishes
directional flow from the arteries into the veins
resulting in a uteroplacental circulation.
34. * Maternal blood carrying oxygen and nutrient substrate to
the placenta must be transferred to the fetal compartment
and this rate of transfer is the rate limiting step in the
process. Therefore the placenta has a significant blood to
facilitate improved exchange.
—
4 Fetal blood enters the placenta via a pair of umbilical
arteries which have numerous branches resulting in fetal
chorionic villi within the placenta, terminating at the
chorionic plate. The fetal chorionic villi are then surrounded
by maternal tissues. This physiology is referred to as
"invasive decidualisation" as the fetal chorionic villi
effectively invade the maternal tissues. Invasive
decidualisation is not present in pigs or sheep.
35. Placental Blood Supply
¢-Oxygen and nutrient rich blood returns to the
fetus via the umbilical vein. Maternal blood is
supplied to the placenta via 80-100 spiral
endometrial arteries which allow the blood
to flow into intervillous spaces facilitating
exchnage. The blood pressure within the
spiral arteries is much higher than that found
in the intervillous spaces resulting in more
efficient nutrient exchange within the
placenta.
36. 'i•Lcreased maternal age
t•Uterine factors:
• Previous CS
• Instrumentation of the uterine cavity (D and C
for miscarriages or Lduced Abortions)
•i*P1acentaI factors:
• Multiparity
• CigareGe smoking
• Living at high altimde
37. 1. Vaginal bleeding
2. Painless but can be associated with
uterine contractions and abdominal pain
3. Bleeding may range from light to severe
4. Gross hematuria
38. fi•Bed rest in lateral position to maximize
venous return and placental perfusion
fi•Women in the third trimester are advised
to avoid sexual intercourse and exercise
and to reduce their activity level
39. Depends upon the extent and severity
of bleeding, the gestational age and
condition of the fems, position of the
placenta and fems and whether the
bleeding has stopped.
t•Caesarean section —
as soon as he baby can
be safely delivered (typically añer 36weeks
gestation). Although emergency CS at any
earlier gestational age may be necessary for
heavy bleeding that cannot be stopped.
'i•Hysterectomy
40. Maternal:
fi• Increased risk of PROM leading to premature labor
fi• Immediate hemorrhage with possible shock and maternal
death
fi• Postpartum hemorrhage
fi• Placenta Accreta
H Accreta Vera —
a term used to denote a placenta with villi
that adhere to the superficial myometrium
4 Increta —
when the villi adheres to the body of the
myometrium, but not through its full thickness
HPercreta —
when the villi penetrate the full thickness of the
myometriuni and may invade neighboring organs such as
the bladder or the rectum
41.
42. 1) Impaired fetal gas exchange related to altered
blood flow and decreased surface area of gas
exchange at site of placental detachment
2) Ineffective Tissue Perfusion related to excessive
bleeding causing fetal compromise
3) Deficient Fluid Volume related to excessive
bleeding
4) Anxiety related to excessive bleeding,
procedures, and possible fetal-maternal
complications
43. ASSESSMENT NURSING
DIAGNOSIS
SUBJECTIVE:
1am having too
much bleeding
in my vagina- as
vetbaliied lay
the patient
laeffective
tisme perfusion
Related to
creased HgB
concentration
in blood &
hypovolemia
secondary to
Placenta previa.
OBJECTIVE
1.Restlessness
2.Confusion
3.Irritability
4.Manifest
eody Weakness
5.C6Qillary rRfill
more than 3 sec
6.OIiguria
V/S taken as
follows:
BP:90/60mm of
Hg
PR:110bpm
RR:20/mt
Temp:36.5 C
GOALS&
DESIRED
OUTCOME
Shon Term:
After 12hrs of
nursing
Intervention the pt
Will demonstrate
Behaviors to
improve
Circulation.
Long term:
After 4 days of
nursing
Intervention the pt
will demonstrate
increased
perfusion as
individually
appropriate
NURSING
INTERVENTION
1. Establish Rapport
2.Monitor vital signs
3.Assess patient
condition
4.Note customary
baseline
Data (usual BP,
weight,Iab values)
5.Determine presRnce of
dysrhthmias
6.Perform blanch test
7.Check for Homans Sign
8.Encourage quiet &
restful
enviornment
9.Elevate head of bed
10. Encourage use of
relaxationm
teqniques
RATIONALE
1. Togain patients trust
2. To obtain baseline
data
3.To assess contributing
factors
4. For comparison with
current findings
5.To identify alterations
from normal
6.To identify/determine
adequate perfusion
7.To determine
presence of thrombus
formation
8. To lessen 02 demand
9.To promote circulation
10.To decrease tension
level
EVALUATION
Short term:
The pt shall
have
demonstrated
behaviors to
improve
circulation.
Long term:
The pt shall
have an
increased
perfusion as
individually
appropriate.
44. • Presented a case of a 47 y/o Multigravida, G9P7A1, with
pregnancy 29 wks + 3 days with PTL t/c PLACENTA
PREVIA, Previous LSCS
• The treatment depends upon the extent and severity of
bleeding, the gestational age and condition of the fetus,
position of the placenta and fetus and whether the bleeding has
stopped.
• Placenta Previa is a medical emergency that needs immediate
management because it can lead to serious maternal and fetal
complications, even death of one or both of them.
• Nurse-led patient education and the provision of a supportive
environment are essential to the optimal management of
Placenta Previa
• Individually tailored and compassionate nursing care of women
with Placenta Previa will serve to enhance the wellbeing of
mother and bab
