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N113 Placenta

N113 - Placental/Bleeding problems

Placenta previa Improperly implanted placenta in lower uterine segment. Can cause painless bleeding.
Low placenta previa Does not cover the cervical opening
Partial placenta previa Partially covers the cervical opening
Complete placenta previa Completely covers cervical opening.
Placenta previa cautions No vaginal exams, may cause tearing. Bed rest, monitor blood loss-pad count, VS & signs of shock, monitor fetal status, lab values
Placenta previa management Depends on type of previa, condition of mother & fetus, amount of bleeding, # of weeks gestation
Abruptio placenta Emergency situation,usually painful. Premature separation of placenta, can cause hemorrhage
Complete abruptio Almost total separation, massive vaginal bleeding, fetal mortality almost 100%.
Abruptio signs & symptoms Painful, sudden bleeding. S/S of shock - increased BP, decreased pulse. Hard uterus, if bleeding is concealed.
Abruptio risks Maternal - death, but uncommon, DIC, renal failure Fetal death from lack of O2.
Abruptio treatment C-section, hydration, transfusion may be necessary, hysterectomy may be needed.
Couvelaire uterus Reduced circulation to uterus, uterus turns blue and will not contract after birth
Hydatidiform mole Molar pregnancy - Chorionic villi of placenta become edematous & fluid-filled grape like clusters.
Ruptured uterus Tearing of uterus, rupture of weakened area - old scar. Risk related to VBAC. Can occur during pregnancy or during labor
Complete rupture Through the 3 muscular layers
Incomplete rupture Tear through endometrium & myometrium
Rupture cause Weakened c-section scar, obstetric trauma - manipulation of fetus, mismanagement of oxytocin, obstructed labor - CPD, congenital or acquired uterine defects, external trauma, VBAC
Signs & symptoms of rupture HEMORRHAGE - resulting in shock Infection - peritonitis - complication PAIN Change in fetal station - fetus rising up in the abdomen, change in abdominal contour, abrupt stop of contractions, fetal distress
Rupture & fetal distress With complete rupture, fetus is forced into abdomen and can die quickly - depends on where the placenta location & where rupture occurs
Rupture treatment C-section, repair if small rupture, hysterectomy if large rupture.
Rh Factor Rh- mom with Rh+ fetus If father is Rh-, children will be Rh-.
Rh screening & management Indirect Coombs test - done on maternal blood, measures antibodies
Direct coombs Done on infant after birth from cord blood
RhoGAM Given 72 postpartum to prevent sensitization. Also given after amniocentesis, abortion and routinely during prenatal care at 28 & 34 weeks to Rh negative women - preventative measure.
Abortion Termination of pregnancy prior to 20 weeks. Either spontaneous or elective.
Abortion patho If embryo dies, this leads to drop in hcG and progesterone during 1st trimester.
Threatened abortion Unexplained bleeding, cramping & backache. Cervix is closed, partial or complete expulsion may occur
Imminent abortion Bleeding & cramping, cervical dilation, membranes may rupture, expulsion WILL occur.
Incomplete abortion Part of conception retained, most often placenta. Cervix is dilated. May require d & c.
Missed abortion Fetus dies but is not expelled. Uterine growth ceases, breast changes regress, brownish vaginal discharge.
Habitual abortion 3 or more consecutive abortions
Treatment during impending loss Monitor for hemorrhage - vitals, pallor, clammy skin, restlessness. If greater than 12 weeks,
Distinguish spotting from abortions Cramping usually present if abortion
Ectopic pregnancy Implantation of blastocyst in site other than uterus
Ectopic implantation sites Fallopian tube, ovary, peritoneal cavity, cervix, uterine cornua
Ectopic symptoms S&S of early pregnancy, hcG found in blood, may have spontaneous abortion. As embryo grows, pain begins.
Ectopic warning signs Sharp, one sided pain, may radiate. Syncope, referred shoulder pain, internal hemorrhage from ruptured tube.
Ectopic treatment Early identification is key. Symptoms can be similar to appendicitis, UTI or ovarian cyst.
Created by: jrb265