PLETA, Jane C.
BSM-2
September 22,2021
Differentiate Placenta Previa and Abruptio Placenta.
PLACENTA PREVIA
It occurs when the placenta is improperly the cervical os.
occurs when a baby's placenta partially or totally covers the mother's cervix — the
outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy
and delivery.
Types of Placenta Previa:
1. Low Implantation - placenta grows over the cervical opening
2. Partial Placenta Previa – the placenta is partly over the cervix
3. Total Placenta Previa - placenta completely covers the internal cervical os. This is
the most dangerous location because of its potential for hemorrhage.
Symptoms
Bright red vaginal bleeding without pain during the second half of pregnancy is
the main sign of placenta previa. Some women also have contractions.
Risk Factors
Placenta previa is more common among women who:
Have had a baby
Have scars on the uterus, such as from previous surgery, including cesarean
deliveries, uterine fibroid removal, and dilation and curettage
Had placenta previa with a previous pregnancy
Are carrying more than one fetus
Are age 35 or older
Are of a race other than white
Smoke
Use cocaine
Complication
Bleeding. Severe, possibly life-threatening vaginal bleeding (hemorrhage) can
occur during labor, delivery or in the first few hours after delivery.
Preterm birth. Severe bleeding may prompt an emergency C-section before your
baby is full term.
Diagnostic Test: Ultrasound
Midwife Intervention:
No sex. Internal Exam(IE) or Enema – these may lead to sudden fetal blood
loss.
Bed rest.
Prepare to induced labor if cervix is ripe or dilated.
Administer IV fluids.
Put mother on NPO in case delivery via C-section is necessary.
Prepare for double set-up (OR/DR)
Secure consent: The surgeon is responsible for the signing of consent and
explanation of the procedure while the nurse/midwife serve as the witness to
the signing.
ABRUPTIO PLACENTA
Is the premature partial or complete separation of a normally implanted placenta. It
usually occurs after the 20th week of gestation.
Placental abruption (abruptio placentae) is an uncommon yet serious complication
of pregnancy. The placenta develops in the uterus during pregnancy. It attaches to
the wall of the uterus and supplies the baby with nutrients and oxygen.
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 bleeding in the mother.
Most common cause of late pregnancy bleeding
Predisposing factors
Preeclampsia and hypertensive disorders
Illicit drug use (especially cocaine)
Accidents
History of placenta abruption
High multiparity
Increasing maternal age
Cigarette smoking
Types of Abruptio placenta
1. Partial abruption
2. Partial abruption with hemorrhage
3. Complete abruption with concealed hemorrhage
Outstanding signs
Dark red, painful vaginal bleeding
Concealed hemorrhage (retroplacental) – rigid board like abdomen
Couvelaire uterus (caused by bleeding in the myometrium – inability of uterus to
contract due to concealed bleeding
Severe abdominal pain
Drop in coagulation factor
Complication
Disseminated Intravascular Coagulopathy (DIC)
Medical management
Emergency caesarian section if maternal and fetal jeopardy is present.
Vaginal delivery if bleeding is heavy but controlled or pregnancy is greater than
36 weeks.
Conservative in hospital observation if both mother and fetus is stable, bleeding is
minimal and contractions are lessened.
Intervention
Infuse IV fluid as ordered
Blood typing and cross matching
Prepare for blood transfusion
Monitor FHR
Insert Foley Catheter
Measure blood loss; count perineal pads
Report signs and symptoms of DIC
Monitor vital signs for shock
Strict I & O
