Transcript A Case Study on:

A Case Presentation on:
PLACENTA
PREVIA
Grace Ruth gladdy mae g. pagaduan
ob-gyne department
February 2013
DEMOGRAPHIC DATA
Name: Mrs. X
Age: 47
Gender: Female
Case Number: 193***
Diagnosis: G9P7A1 29 weeks + 3 days,
PTL T/C Placenta Previa, Previous LCCS
PHYSICAL ASSESSMENT
General Appearance:
Well-groomed
Cooperative
Weak-looking
PHYSICAL ASSESSMENT
Vital Signs:
Blood Pressure: 120/80
Pulse Rate: 72
Respiratory Rate: 23
Temperature: 36.8
PHYSICAL ASSESSMENT
Head and Neck:
Facial symmetry
Absence of scalp tenderness
Absence of lesions nor masses noted
Iris are black, pupils are equally round and reactive to
light accommodation
 With white and clear sclera
 Pinna is of same color with the facial skin, smooth and
aligned with eye level
 Able to hear sound clearly as claimed
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PHYSICAL ASSESSMENT
Head and Neck:
 Absence of pain, inflammation or drainages
 With patent and clear nostrils
 Absence of nasal flaring, congestion or drainages
 Tongue and uvula are centrally positioned
 Lingual tonsils at the posterior portion of the
tongue
 Has good oral hygiene, no halitosis
 Jugular vein not distended
 No swollen lymph nodes as palpated
PHYSICAL ASSESSMENT
Thorax:
 Symmetrical chest wall upon movement
and breathing on room air
 Breath sounds are clear
Cardiovascular:
Absence of chest pain
Normal peripheral pulse
PHYSICAL ASSESSMENT
Genitourinary:
 Minimal vaginal spotting up to 2-3pads per day
 No discharges nor foul smell
 Able to void freely
 Urine is clear
 No pain in urination
Gastrointestinal:
 Mild hypogastric pain
 Abdomen is soft
 With mild to moderate uterine contraction
 With active bowel sounds
 No abdominal tenderness
PHYSICAL ASSESSMENT
Musculoskeletal:
 No physical deformities nor paralysis
 With active ROM
 Joints can move freely without any resistance
or pain
Neurologic:
 Awake, alert and oriented to time, person
and place
 Understands written and spoken language
and responds accurately
 Able to follow commands
PATIENT HISTORY
I. PAST MEDICAL HISTORY
 With history of Abortion.
Surgical history of LSCS 5x.
Obstetrical History
PATIENT HISTORY
II. PRESENT MEDICAL HISTORY
 Patient 193*** is a referral from another hospital with
chief complaint of vaginal spotting at 10:30 AM
associated with mild hypogastric pain.
 G9P7A1 29 3/7 weeks Age of Gestation
 LMP: Unknown
 PV not done
 No allergies to any food or drug
 With Hypertensive and Diabetic parents
MEDICATIONS:
dexamethasone
Ferrous
INVESTIGATIONS:
INVESTIGATIONS:
• Ultrasonographic Result
PU 31weeks + 5days AOG by fetal biometry
Live Singleton in cephalic presentation, Male
fetus
Good Cardiac and somatic activity
Left Lateral Placenta, Grade II, Previa Totalis
Adequate fluid volume
BPP= 8/8
Actual Ultrasound Result
bladder
Uterus
INVESTIGATIONS:
• 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.
PATHOPHYSIOLOGY
TOPIC PRESENTATION
INTRODUCTION:
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:
• Complete placenta previa, where the placenta completely covers the
internal os.
• Partial placenta previa, where the placenta partially covers the
internal os. Thus, this scenario happens only when the internal os is
dilated to some degree.
• Marginal placenta previa, which just reaches the internal os, but does
not cover it.
• Low lying placenta, which extends into the lower uterine segment but
does not reach the internal os.
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ANATOMY AND PHYSIOLOGY
ETIOLOGY
Increased maternal age
Uterine factors:
• Previous CS
• Instrumentation of the uterine cavity (D and C
for miscarriages or Induced Abortions)
Placental factors:
• Multiparity
• Cigarette smoking
• Living at high altitude
SIGNS AND SYMPTOMS
Vaginal bleeding
Painless but can be associated with uterine
contractions and abdominal pain
Bleeding may range from light to severe
Gross hematuria
INTERVENTION
Bed rest in lateral position to maximize
venous return and placental perfusion
Women in the third trimester are advised
to avoid sexual intercourse and exercise
and to reduce their activity level
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.
 Caesarean section – as soon as he baby can be
safely delivered (typically after 36weeks
gestation). Although emergency CS at any
earlier gestational age may be necessary for
heavy bleeding that cannot be stopped.
 Hysterectomy
Conservative
Management, bed rest
Continuous maternal
fetal monitoring
and
Blood transfusion and
IVF for heavy bleeding
CBC, blood typing and
cross matching of at least
4 units of blood
Tocolytics
(Nifedipine
TID)
10mg
Corticosteroids
(Dexamethasone
6mg IM q6 for
24hours)
COMPLICATIONS
Maternal:
 Increased risk of PROM leading to premature labor
 Immediate hemorrhage with possible shock and maternal death
 Postpartum hemorrhage
 Placenta Accreta
 Accreta Vera – a term used to denote a placenta with villi that
adhere to the superficial myometrium
 Increta – when the villi adheres to the body of the myometrium,
but not through its full thickness
 Percreta – when the villi penetrate the full thickness of the
myometrium and may invade neighboring organs such as the
bladder or the rectum
Fetal:
Abnormal
fetal
(breech)
Reduced fetal growth
Prematurity
presentation
PRIORITIZATION OF
NURSING PROBLEMS
 Impaired fetal gas exchange related to altered
blood flow and decreased surface area of gas
exchange at site of placental detachment
 Ineffective Tissue Perfusion related to excessive
bleeding causing fetal compromise
 Deficient Fluid Volume related to excessive
bleeding
 Anxiety related to excessive bleeding,
procedures, and possible fetal-maternal
complications
NCP: IMPAIRED FETAL GAS EXCHANGE
NCP: DEFICIENT FLUID VOLUME
CONCLUSION
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. Once diagnosed, close observation
must be done to monitor the status of both
the mother and the baby. Any untoward
symptom must be urgently referred to the
attending physician. Complications can be
diminished if the diagnosis and management
are done at an early stage.
THANK
YOU!