Case Presentation on
Placenta Previa in
Pregnancy
Presented by
Ankana Ghosh Dey
Ambika Ghosh
Runa Dey
LipikaMallick
Introduction
Definition
Patient Picture
Types
Pathophysiology
Predisposing factor. Precipitating factors
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Increase progesterone and oestrogen level
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Preembryonic stage
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Production of fertilized ovum
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Implantation in the uterus,
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Embryonic stage
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Placent are arise from the tropoblast tissue
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Insufficient blood
Placenta migrates to where there is sufficient blood supply
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Placenta resides in the lower
Total ↗️Partial ↗️ Marginal ↗️Low lying
Clinical Features
Symptoms:
Vaginal Bleeding
👉 Sudden Onset
👉 Painless
👉 causeless
👉 Recurrent
Signs
✨General condition and anaemia proportionate to blood loss
✨ Abdominal examination
👉 height of uterus proportionate to gestational age
👉 Uterus feels soft and relaxed
👉 Mal presentation is common
👉 Fetal heart sound is usually present
Cont….
Vulval inspection.
👉bright red or dark colored bleeding
👉 Placenta is felt on lower segment
💥vaginal examination must not be done
Complication
Maternal Complication
During Pregnancy
Malpresentation
Premature labor
During Labor
Early Rupture of membrane
Cord prolapse
Slow dilation of cervix
Interapartum hemorrhage
Operative interference
PPH
During Puperium
Sepsis
Sub-Involution
Embolism
Fetal Complication
Low birth weight
Fetal growth Restriction
Fetal Asphyxia
Birth Injuries
Congenital Malformation
Diagnostic Evaluation
Trans abdominal Sonography
Trans vaginal Sonography(TVS)
Trans Perineal Sonography
Color Doppler
MRI
Management
Prevention
Immediate management
Expectant management
Active management
Nursing Management
Prevention
Regular Antenatal Care
Routine Ultrasound
Significance of warning haemorrhage
If bleeding at home
Put her on bed immediately
Assess for blood loss
Transfer mother to hospital
Immediate Attention
Note amount of blood loss
Take blood samples
Large bore cannulation & NS infusion
Gentle Abdominal Palpation
Inspection of Vulva
Schematic Management
CONTD..
Active management
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.
Nursing Management
Nursing Diagnosis
Decreased cardiac output related to blood loss as evidenced by increase in
heart rate.
Ineffective tissue perfusion related to decrease in Hb% in blood as evidenced
by dyspnea.
Deficient fluid volume related to Blood Loss as evidenced by vital signs
changes.
Fear related to outcome of pregnancy as evidenced by facial expressions of the
mother or frequent questioning.
Impaired fetal gas exchange related to decreased placental surface area as
evidenced by changed in FHS.
Prognosis
Maternal
Fetal
Any question
Questionnaires
1.What is the Significant characteristic of vaginal bleeding in
Placenta Praevia.
a) Odorless
b) Painless
2.What will be the fetal complication in Placenta Previa.
c) Low birth weight baby
d) Big baby
THANK YOU