SlideShare a Scribd company logo
1 of 37
PLACENTA PRAEVIA
Presented by:
Prabhjot Kaur
M.Sc.(N) 1st
Year
CON, Adesh University
DEFINITION
• The placenta is implanted partially or
completely over the lower uterine segment
(over or adjacent to the internal os ) it is called
Placenta Praevia.
D.C.Dutta
DEFINITION
• In Placenta Praevia the placenta is implanted
in the lower uterine segment such that is
completely or partially cover the cervix or is
close enough to the cervix to cause bleeding
when the cervix dilated or the lower uterine
segment effaces.
(Hull and Resnik, 2009)
Placenta previa
INCIDENCE
• In 80% cases it is found in multiparous
women.
• The incidence is increased beyond the age of
35, with high birth order pregnancies and in
multiple pregnancy.
• The incidences approximately 4-5 per
thousand pregnancies.
RISK FACTORS
• Multiparity
• Increased maternal age
• Higher altitude
• History of previous scar in the uterus.
• Smoking
TYPES
There are four types of placenta praevia
depending upon the degree of extension of
placenta to the lower segment.
• Type 1 (Low lying)
• Type 2 (Marginal)
• Type 3 ( Incomplete or partial central )
• Type 4 ( Central or total)
Placenta previa
CONTD..
Type 1 (Low lying) :
The major part of placenta is attached to
the upper segment and only the lower
margin encroaches onto the lower
segment but not to the os.
CONTD…
Type 2 (Marginal) :
The placenta reaches
the margin of internal
os but does not cover
it.
CONTD…
Type 3 ( Incomplete or partial central ) :
The placenta covers the internal os partially
( cover the internal os when closed but does
not entirely do so when fully dilated)
CONTD…
Type 4 ( Central or total) :
The placenta completely covers the internal
os even after it is fully dilated.
Placenta previa
CLINICAL FEATURES
Symptoms
Vaginal bleeding:
• sudden in onset, painless
• revealed bleeding (fresh blood)
• Bright red or dark colored
• Unrelated to activity
CONTD…
Signs:
• General condition and anaemia are
proportionate to the visible blood loss
Abdominal examination: the size of the uterus
• Uterus feels relaxed and soft.
• The head is floating in contrast to the period of
gestation.
• Fetal heart sound is usually present.
CONTD…
• Vaginal inspection:
Placenta is felt on the lower segment.
COMPLICATIONS
Complications of Placenta Praevia:
1.Maternal complications:
• During Pregnancy
• During labour
• Puerperium
2. Fetal complications
MATERNAL COMPLICATIONS
During pregnancy:
• Antepartum haemorrhage
• Malpresentation
• Premature labour
CONTD…
During labour:
• Early rupture of membranes
• Cord prolapse
• Slow dilatation of the cervix
• Intrapartum haemorrhage
CONTD…
Puerperium:
• Postpartum haemorrhage
• Retained placenta
• Subinvolution
Fetal complication
• Low birth weight
• Asphyxia
• Intrauterine death
DIAGNOSIS
Placentography :
Sonography
Color Doppler flow study
Magnetic resonance
Vaginal examination
MANAGEMENT
• Prevention
• Immediate management
• Expectant management
• Active management
• Nursing Management
PREVENTION
To minimize the risks , the following guidelines are
useful.
• Adequate antenatal care
• Significance of warning haemorrhage
At Home –
• Put the patient on bed .
• Abdominal examination
• Vaginal examination must not be done.
Transfer To Hospital
• Admission To Hospital
IMMEDIATE ATTENTION
• To ensure an adequate blood supply to a
women and fetus place the women
immediately on bed rest in a side lying
position.
• A large bore IV cannula is cited and
infusion of normal saline
• Gentle abdominal palpation
Scheme Of Management
All APH patients are to be admitted
General and abdominal examination
Clinical assessment of blood loss
Resuscitation if necessary
Localisation of placenta
• Expectant management Active interference
Expectant management
The expectant treatment is carried upto 37 weeks.
Aim: The aim is to continue pregnancy for fetal
maturity without compromising the maternal
health.
Indications:
• No active bleeding
• Patient stable haemo-dynamically
• FHS- good
• CTG- reactive fetus
CONTD…
Interventions:
• Bed rest
• Periodic inspection of vulvul pads
• Supplementary haematinics if patient is
anaemic
• Use of tocolytics.
• Rh immunoglobulins to all Rh negative
women.
Active management
Indications:
• Bleeding occurs at or after 37 weeks of
pregnancy
• Patient is in labour
• FHS- absent
• Gross fetal malformation
• Dead fetus
CONTD…
Active management
Vaginal delivery Caesarean delivery
Placental edge is within 2 cm from the
internal os: in this case no internal
examination is performed and caesarean
section is considered as the best choice.
CONTD…
Placental edge is 2-3 cm away from the internal cervical os:
Internal examination in OT
ARM with or without oxytocin
Satisfactory progress of labour bleeding continues
& no labour initiation
vaginal delivery caesarean delivery
NURSING MANAGEMENT
Nursing Diagnosis
Decreased cardiac output related to blood loss
as manifested by increase in heart rate.
Interventions:
• Monitor Vital Signs
• Provide adequate rest &
• reposition client
• Encourage relaxation techniques
• Elevate Hb of the client
•
Ineffective tissue perfusion related to
decrease in Hb in blood as manifested
by dyspnea.
Interventions:
• Monitor Vital Signs.
• Encourage quiet & restful environment.
• Encourage use of relaxation techniques.
• Provide supplemental oxygen to the client
as prescribed by the physician.
Deficient fluid volume related to Blood
Loss as manifested by vital signs
changes.
Interventions:
• Monitor Vital Signs
• Monitor FHR.
• Initiate IV fluids as ordered by the
physician.
• Place the patient in left lateral position.
Fear related to outcome of pregnancy as
manifested by facial expressions of the
mother.
Nursing Interventions
• Assess fetal heart sounds.
• Allow the mother to share her feelings.
• Answer the mother’s questions honestly.
• Include the mother in the planning of the
care plan for both the mother and the baby.
Bibliography
• Perry, Hockenberry, Lowdermilk et al. Maternal Child
Nursing Care. Elsevier. 5th
edition; 326-329
• Cunningham, Leveno, Bloom et al. Williams Obstetrics. Mc
graw Hill Education. 24th
edition; 801-807
• D.C.Dutta’s . Textbook of Obstetrics. New central Book
Agency(P) Ltd. 7th
edition; 241-250
• Renu mishra.IAN DONALD’S Practical Obstetric
problems. Wolters kluwer. 7th
edition ; 315-320
• Adele pillitteri. Maternal and child health nursing. Walters
kluwer. 7th
edition;562-565.
THANK YOU

More Related Content

What's hot (20)

Prolonged labour
Prolonged labourProlonged labour
Prolonged labour
 
Episiotomy
EpisiotomyEpisiotomy
Episiotomy
 
Breech presentation
Breech presentationBreech presentation
Breech presentation
 
HYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUMHYPEREMESIS GRAVIDARUM
HYPEREMESIS GRAVIDARUM
 
Eclampsia ppt
Eclampsia pptEclampsia ppt
Eclampsia ppt
 
Non-stress test, and contraction stress test, presentation
Non-stress test, and contraction stress test,  presentationNon-stress test, and contraction stress test,  presentation
Non-stress test, and contraction stress test, presentation
 
pre eclampsia
pre eclampsiapre eclampsia
pre eclampsia
 
Vaginal examination
Vaginal examinationVaginal examination
Vaginal examination
 
Abruptio placentae
Abruptio placentae Abruptio placentae
Abruptio placentae
 
Third stage of labour
Third stage of labourThird stage of labour
Third stage of labour
 
Mechanism of labour
Mechanism of labourMechanism of labour
Mechanism of labour
 
Antenatal care
Antenatal careAntenatal care
Antenatal care
 
Rupture of the uterus
Rupture of the uterusRupture of the uterus
Rupture of the uterus
 
Threatened abortion
Threatened abortion Threatened abortion
Threatened abortion
 
Antepartum haemorrhage
Antepartum haemorrhageAntepartum haemorrhage
Antepartum haemorrhage
 
Multiple pregnancy
Multiple pregnancyMultiple pregnancy
Multiple pregnancy
 
Polyhydramios
PolyhydramiosPolyhydramios
Polyhydramios
 
Premature labour
Premature labourPremature labour
Premature labour
 
Postpartum hemorrhage
Postpartum hemorrhage Postpartum hemorrhage
Postpartum hemorrhage
 
hydatidiform mole
hydatidiform molehydatidiform mole
hydatidiform mole
 

Similar to Placenta previa

BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptx
BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptxBLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptx
BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptxRenjini R
 
APH.pptx
APH.pptxAPH.pptx
APH.pptxMrsP6
 
najmi placenta previa final 4.pdf
najmi placenta previa final 4.pdfnajmi placenta previa final 4.pdf
najmi placenta previa final 4.pdfnajmishafiz
 
PLACENTA PREVIA. a disorder of Pregnancy
PLACENTA PREVIA. a disorder of PregnancyPLACENTA PREVIA. a disorder of Pregnancy
PLACENTA PREVIA. a disorder of Pregnancyvirengeeta
 
Antepartum hemorrhage
Antepartum hemorrhageAntepartum hemorrhage
Antepartum hemorrhagesamar zidan
 
PLACENTA PRAEVIA-1.pptx
PLACENTA PRAEVIA-1.pptxPLACENTA PRAEVIA-1.pptx
PLACENTA PRAEVIA-1.pptxMohammad Naik
 
Antepartum haemorrhage, placenta previa and abruptio placentae
Antepartum haemorrhage, placenta previa and abruptio placentaeAntepartum haemorrhage, placenta previa and abruptio placentae
Antepartum haemorrhage, placenta previa and abruptio placentaeIram Chaudhry
 
Antepartum haemorhage
Antepartum haemorhageAntepartum haemorhage
Antepartum haemorhageDrNadir Khan
 
ANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptxANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptxMrsP6
 
Ante partum haemorrhage by dr wyo
Ante partum haemorrhage by dr wyoAnte partum haemorrhage by dr wyo
Ante partum haemorrhage by dr wyoPyar Tho
 
Antepartum heamorrhage.pptx
Antepartum heamorrhage.pptxAntepartum heamorrhage.pptx
Antepartum heamorrhage.pptxMikelMMarshall
 
Group 4 assignment 1.pptx
Group 4 assignment 1.pptxGroup 4 assignment 1.pptx
Group 4 assignment 1.pptxznfq8kmwhz
 
Bleeding in late pregnancy
Bleeding in late pregnancy Bleeding in late pregnancy
Bleeding in late pregnancy Mostafa Shakshak
 

Similar to Placenta previa (20)

Obg seminar
Obg seminarObg seminar
Obg seminar
 
BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptx
BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptxBLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptx
BLEEDING DISORDERS IN LATE PREGNANCY-Renjini.R....pptx
 
Antepartum hemorrhage
Antepartum hemorrhageAntepartum hemorrhage
Antepartum hemorrhage
 
APH.pptx
APH.pptxAPH.pptx
APH.pptx
 
Antepartum haemorrhage
Antepartum haemorrhageAntepartum haemorrhage
Antepartum haemorrhage
 
najmi placenta previa final 4.pdf
najmi placenta previa final 4.pdfnajmi placenta previa final 4.pdf
najmi placenta previa final 4.pdf
 
PLACENTA PREVIA. a disorder of Pregnancy
PLACENTA PREVIA. a disorder of PregnancyPLACENTA PREVIA. a disorder of Pregnancy
PLACENTA PREVIA. a disorder of Pregnancy
 
ABRUPTIO PLACENTAE
ABRUPTIO PLACENTAEABRUPTIO PLACENTAE
ABRUPTIO PLACENTAE
 
Aph
AphAph
Aph
 
Antepartum hemorrhage
Antepartum hemorrhageAntepartum hemorrhage
Antepartum hemorrhage
 
PLACENTA PRAEVIA-1.pptx
PLACENTA PRAEVIA-1.pptxPLACENTA PRAEVIA-1.pptx
PLACENTA PRAEVIA-1.pptx
 
Antepartum haemorrhage, placenta previa and abruptio placentae
Antepartum haemorrhage, placenta previa and abruptio placentaeAntepartum haemorrhage, placenta previa and abruptio placentae
Antepartum haemorrhage, placenta previa and abruptio placentae
 
Antepartum haemorhage
Antepartum haemorhageAntepartum haemorhage
Antepartum haemorhage
 
ANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptxANTEPARTUM HAEMORRHAGE.pptx
ANTEPARTUM HAEMORRHAGE.pptx
 
Ante partum haemorrhage by dr wyo
Ante partum haemorrhage by dr wyoAnte partum haemorrhage by dr wyo
Ante partum haemorrhage by dr wyo
 
antepartum haemorrhage
antepartum haemorrhageantepartum haemorrhage
antepartum haemorrhage
 
Antepartum heamorrhage.pptx
Antepartum heamorrhage.pptxAntepartum heamorrhage.pptx
Antepartum heamorrhage.pptx
 
Group 4 assignment 1.pptx
Group 4 assignment 1.pptxGroup 4 assignment 1.pptx
Group 4 assignment 1.pptx
 
Bleeding in late pregnancy
Bleeding in late pregnancy Bleeding in late pregnancy
Bleeding in late pregnancy
 
Placenta praevia
Placenta praeviaPlacenta praevia
Placenta praevia
 

Recently uploaded

CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...Nguyen Thanh Tu Collection
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17Celine George
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxKatherine Villaluna
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfYu Kanazawa / Osaka University
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesCeline George
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsEugene Lysak
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxraviapr7
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxAditiChauhan701637
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfTechSoup
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17Celine George
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational PhilosophyShuvankar Madhu
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxEduSkills OECD
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxDr. Asif Anas
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxheathfieldcps1
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfMohonDas
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfMohonDas
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapitolTechU
 

Recently uploaded (20)

CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
CHUYÊN ĐỀ DẠY THÊM TIẾNG ANH LỚP 11 - GLOBAL SUCCESS - NĂM HỌC 2023-2024 - HK...
 
How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17How to Add Existing Field in One2Many Tree View in Odoo 17
How to Add Existing Field in One2Many Tree View in Odoo 17
 
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptxPractical Research 1: Lesson 8 Writing the Thesis Statement.pptx
Practical Research 1: Lesson 8 Writing the Thesis Statement.pptx
 
Prelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quizPrelims of Kant get Marx 2.0: a general politics quiz
Prelims of Kant get Marx 2.0: a general politics quiz
 
Finals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quizFinals of Kant get Marx 2.0 : a general politics quiz
Finals of Kant get Marx 2.0 : a general politics quiz
 
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdfP4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
P4C x ELT = P4ELT: Its Theoretical Background (Kanazawa, 2024 March).pdf
 
How to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 SalesHow to Manage Cross-Selling in Odoo 17 Sales
How to Manage Cross-Selling in Odoo 17 Sales
 
The Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George WellsThe Stolen Bacillus by Herbert George Wells
The Stolen Bacillus by Herbert George Wells
 
Prescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptxPrescribed medication order and communication skills.pptx
Prescribed medication order and communication skills.pptx
 
In - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptxIn - Vivo and In - Vitro Correlation.pptx
In - Vivo and In - Vitro Correlation.pptx
 
UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024UKCGE Parental Leave Discussion March 2024
UKCGE Parental Leave Discussion March 2024
 
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdfMaximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
Maximizing Impact_ Nonprofit Website Planning, Budgeting, and Design.pdf
 
How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17How to Show Error_Warning Messages in Odoo 17
How to Show Error_Warning Messages in Odoo 17
 
Philosophy of Education and Educational Philosophy
Philosophy of Education  and Educational PhilosophyPhilosophy of Education  and Educational Philosophy
Philosophy of Education and Educational Philosophy
 
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptxPISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
PISA-VET launch_El Iza Mohamedou_19 March 2024.pptx
 
Ultra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptxUltra structure and life cycle of Plasmodium.pptx
Ultra structure and life cycle of Plasmodium.pptx
 
The basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptxThe basics of sentences session 10pptx.pptx
The basics of sentences session 10pptx.pptx
 
HED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdfHED Office Sohayok Exam Question Solution 2023.pdf
HED Office Sohayok Exam Question Solution 2023.pdf
 
Diploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdfDiploma in Nursing Admission Test Question Solution 2023.pdf
Diploma in Nursing Admission Test Question Solution 2023.pdf
 
CapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptxCapTechU Doctoral Presentation -March 2024 slides.pptx
CapTechU Doctoral Presentation -March 2024 slides.pptx
 

Placenta previa

  • 1. PLACENTA PRAEVIA Presented by: Prabhjot Kaur M.Sc.(N) 1st Year CON, Adesh University
  • 2. DEFINITION • The placenta is implanted partially or completely over the lower uterine segment (over or adjacent to the internal os ) it is called Placenta Praevia. D.C.Dutta
  • 3. DEFINITION • In Placenta Praevia the placenta is implanted in the lower uterine segment such that is completely or partially cover the cervix or is close enough to the cervix to cause bleeding when the cervix dilated or the lower uterine segment effaces. (Hull and Resnik, 2009)
  • 5. INCIDENCE • In 80% cases it is found in multiparous women. • The incidence is increased beyond the age of 35, with high birth order pregnancies and in multiple pregnancy. • The incidences approximately 4-5 per thousand pregnancies.
  • 6. RISK FACTORS • Multiparity • Increased maternal age • Higher altitude • History of previous scar in the uterus. • Smoking
  • 7. TYPES There are four types of placenta praevia depending upon the degree of extension of placenta to the lower segment. • Type 1 (Low lying) • Type 2 (Marginal) • Type 3 ( Incomplete or partial central ) • Type 4 ( Central or total)
  • 9. CONTD.. Type 1 (Low lying) : The major part of placenta is attached to the upper segment and only the lower margin encroaches onto the lower segment but not to the os.
  • 10. CONTD… Type 2 (Marginal) : The placenta reaches the margin of internal os but does not cover it.
  • 11. CONTD… Type 3 ( Incomplete or partial central ) : The placenta covers the internal os partially ( cover the internal os when closed but does not entirely do so when fully dilated)
  • 12. CONTD… Type 4 ( Central or total) : The placenta completely covers the internal os even after it is fully dilated.
  • 14. CLINICAL FEATURES Symptoms Vaginal bleeding: • sudden in onset, painless • revealed bleeding (fresh blood) • Bright red or dark colored • Unrelated to activity
  • 15. CONTD… Signs: • General condition and anaemia are proportionate to the visible blood loss Abdominal examination: the size of the uterus • Uterus feels relaxed and soft. • The head is floating in contrast to the period of gestation. • Fetal heart sound is usually present.
  • 16. CONTD… • Vaginal inspection: Placenta is felt on the lower segment.
  • 17. COMPLICATIONS Complications of Placenta Praevia: 1.Maternal complications: • During Pregnancy • During labour • Puerperium 2. Fetal complications
  • 18. MATERNAL COMPLICATIONS During pregnancy: • Antepartum haemorrhage • Malpresentation • Premature labour
  • 19. CONTD… During labour: • Early rupture of membranes • Cord prolapse • Slow dilatation of the cervix • Intrapartum haemorrhage
  • 20. CONTD… Puerperium: • Postpartum haemorrhage • Retained placenta • Subinvolution
  • 21. Fetal complication • Low birth weight • Asphyxia • Intrauterine death
  • 22. DIAGNOSIS Placentography : Sonography Color Doppler flow study Magnetic resonance Vaginal examination
  • 23. MANAGEMENT • Prevention • Immediate management • Expectant management • Active management • Nursing Management
  • 24. PREVENTION To minimize the risks , the following guidelines are useful. • Adequate antenatal care • Significance of warning haemorrhage At Home – • Put the patient on bed . • Abdominal examination • Vaginal examination must not be done. Transfer To Hospital • Admission To Hospital
  • 25. IMMEDIATE ATTENTION • To ensure an adequate blood supply to a women and fetus place the women immediately on bed rest in a side lying position. • A large bore IV cannula is cited and infusion of normal saline • Gentle abdominal palpation
  • 26. Scheme Of Management All APH patients are to be admitted General and abdominal examination Clinical assessment of blood loss Resuscitation if necessary Localisation of placenta • Expectant management Active interference
  • 27. Expectant management The expectant treatment is carried upto 37 weeks. Aim: The aim is to continue pregnancy for fetal maturity without compromising the maternal health. Indications: • No active bleeding • Patient stable haemo-dynamically • FHS- good • CTG- reactive fetus
  • 28. CONTD… Interventions: • Bed rest • Periodic inspection of vulvul pads • Supplementary haematinics if patient is anaemic • Use of tocolytics. • Rh immunoglobulins to all Rh negative women.
  • 29. Active management Indications: • Bleeding occurs at or after 37 weeks of pregnancy • Patient is in labour • FHS- absent • Gross fetal malformation • Dead fetus
  • 30. CONTD… Active management Vaginal delivery Caesarean delivery Placental edge is within 2 cm from the internal os: in this case no internal examination is performed and caesarean section is considered as the best choice.
  • 31. CONTD… Placental edge is 2-3 cm away from the internal cervical os: Internal examination in OT ARM with or without oxytocin Satisfactory progress of labour bleeding continues & no labour initiation vaginal delivery caesarean delivery
  • 32. NURSING MANAGEMENT Nursing Diagnosis Decreased cardiac output related to blood loss as manifested by increase in heart rate. Interventions: • Monitor Vital Signs • Provide adequate rest & • reposition client • Encourage relaxation techniques • Elevate Hb of the client •
  • 33. Ineffective tissue perfusion related to decrease in Hb in blood as manifested by dyspnea. Interventions: • Monitor Vital Signs. • Encourage quiet & restful environment. • Encourage use of relaxation techniques. • Provide supplemental oxygen to the client as prescribed by the physician.
  • 34. Deficient fluid volume related to Blood Loss as manifested by vital signs changes. Interventions: • Monitor Vital Signs • Monitor FHR. • Initiate IV fluids as ordered by the physician. • Place the patient in left lateral position.
  • 35. Fear related to outcome of pregnancy as manifested by facial expressions of the mother. Nursing Interventions • Assess fetal heart sounds. • Allow the mother to share her feelings. • Answer the mother’s questions honestly. • Include the mother in the planning of the care plan for both the mother and the baby.
  • 36. Bibliography • Perry, Hockenberry, Lowdermilk et al. Maternal Child Nursing Care. Elsevier. 5th edition; 326-329 • Cunningham, Leveno, Bloom et al. Williams Obstetrics. Mc graw Hill Education. 24th edition; 801-807 • D.C.Dutta’s . Textbook of Obstetrics. New central Book Agency(P) Ltd. 7th edition; 241-250 • Renu mishra.IAN DONALD’S Practical Obstetric problems. Wolters kluwer. 7th edition ; 315-320 • Adele pillitteri. Maternal and child health nursing. Walters kluwer. 7th edition;562-565.