Class notes Care of Mother and Child at Risk (NCM109)

MATERNAL AND PEDIATRIC LECTURE
DISEASES IN
PREGNANCY

OUTLINE o Partial placenta previa- occurs when the
internal os is partially covered by the
A. Placenta Previa and Abruptio Placenta placenta
B. Incompetent Cervix
C. Ectopic Pregnancy
D. H-mole
E. Tuberculosis in Pregnancy



A. PLACENTA PREVIA AND ABRUPTIO PLACENTA


o Marginal placenta previa- occurs when the
I. Placenta Previa
placenta is at the margin/edge of the
- the development of the placenta in the lower uterine
segment, partially or completely covering the internal internal os
cervical os
- obstetric complication in which the placenta is
attached to the uterine wall close to or covering
the cervix
- usually during the second or third trimester, but can
also occur in the first trimester
- leading cause of ante-partum hemorrhage. It affects
approximately 0.5% of all labors.

o Low-lying placenta previa- occurs when the
placenta is implanted in the lower uterine
segment. In this variation, the edge of the
placenta is near the internal os but does not
reach it




1. TYPES:




2. Causes:
o The cause of placenta previa is unknown
o Endometrial damage from previous
pregnancies and defective decidual
vascularization have been postulated as
possible mechanisms.
o Total placenta previa- occurs when the
internal cervical os is completely covered by
the placenta.

, MATERNAL AND PEDIATRIC LECTURE
DISEASES IN
PREGNANCY

ASSOCIATED CONDITIONS o Trans abdominal ultrasonography confirms
1. Maternal age. Placenta previa is three times suspicion of placenta Previa
more common at age 35 than at age 25 o CBC – decreased Hb and HCT levels if
2. Increasing parity bleeding is present
3. Previous uterine scar 7. TREATMENT
4. Prior placenta previa o 36 weeks pregnant or more with
5. Tobacco and cocaine use documented fetal lung maturity –
6. Multiple gestation
immediate delivery via CS
7. Previous myomectomy to remove fibroid
o Marginal placenta Previa with documented
fetal lung maturity – perform double setup
SIGNS AND SYMPTOMS examination to determine whether the
1. Most common symptom is painless bleeding patient is a candidate for a trial of vaginal
during the third trimester delivery
2. Premature contractions o anterior placenta previa - Low vertical
3. Baby is breech or in transverse presentation uterine incision is probably safer
4. Uterus measures larger than it should o Cesarean delivery may be performed
according to gestational age regardless of gestational age if hemorrhage
is severe and jeopardizes the mother or
fetus
8. POSSIBLE COMPLICATIONS
3. NURSING MANAGEMENT:
o Death
o Ensure the physiologic well-being of the
o Hemorrhage
client and fetus
o Shock
o Provide client and family teaching
o Address emotional and psychosocial needs
OTHER RISK FACTORS
4. HEALTH TEACHING
1. Previous placenta previa, CS delivery, or D &
o Maintain a bed rest
C
o Maintain a 8 glasses of water 2. Previous pregnancies, especially a large
5. NURSING INTERVENTIONS: number of closely spaced pregnancies (at
o Assess vital signs higher risk)
o Maintain bed rest or chair rest when 3. Women younger than 20; women older than
indicated 30 (increased risk as they got older)
o Monitor amount and time of sleeping 4. Women with large placenta from twins or
o Position mother on her left side erythroblastosis
o Restrict vaginal examination 5. Women who smoke or use cocaine
o Monitor uterine contractions and FHR by 6. Race; some studies finding that people from
external monitor • Asia and Africa are at higher risk and others
finding no difference
o Monitor amount of blood loss, pain level,
and uterine contractility
o Assess maternal vital signs 9. EFFECTS ON PREGNANCY AND LABOR
o Monitor lab status o Abnormal presentation and position
o Emotional support o Premature labor
o Prepare for CS o Prolonged labor
o Monitor tocolytic agents o More chances of surgical intervention
6. LABORATORY FINDINGS