MICRO TEACHING ON

PLACENTA PREVIA

SUBMITTED TO SUBMITTED BY

Mrs.Ritangali Sahoo Mrs.Suchismita Sahu

HOD OBG Department 1st year Msc Nursing

College Of Nursing,Cuttack College of nursing, cuttack

DATE:-

PLACE:-

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 INDEX
SI NO CONTENT PAGE NO
1 INTRODUCTION 3
2 SIGN AND SYMPTOM 4
3 COUSES 4
4 RISK FACTORS 4-5
5 CLASSIFICATION 5-6
6 DIAGNOSIS 6
7 CONFIRMATORY 6-7
8 MANAGEMENT 7
9 DELIVERY 7-8
10 COMPLICATION 8
11 SUMMARY 9
BIBLIOGRAPHY 10

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 PLACENTA PREVIA
INTRODUTION:-
Placenta praevia is when the placenta attaches inside
the uterus but in an abnormal position near or over the cervical
opening. Symptoms include vaginal bleeding in the second half of
pregnancy. The bleeding is bright red and tends not to be associated
with pain. Complications may include placenta accreta, dangerously
low blood pressure, or bleeding after delivery. Complications for the
baby may include fetal growth restriction.
Risk factors include pregnancy at an older age and smoking as well
as prior cesarean section, labor induction, or termination of
pregnancy. Diagnosis is by ultrasound. It is classified as
a complication of pregnancy.
For those who are less than 36 weeks pregnant with only a small
amount of bleeding recommendations may include bed rest and
avoiding sexual intercourse.
 For those after 36 weeks of pregnancy or with a significant amount
of bleeding, cesarean section is generally recommended.
 In those less than 36 weeks pregnant, corticosteroids may be given
to speed development of the baby's lungs.
 Cases that occur in early pregnancy may resolve on their own.
It affects approximately 0.5% of pregnancies.
After four cesarean sections, however, it affects 10% of pregnancies.
 Rates of disease have increased over the late 20th century and early
21st century.
The condition was first described in 1685 by Paul Portal.

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SIGN AND SYMPTOMS:-
 Women with placenta previa often present with painless,
bright red vaginal bleeding. This commonly occurs around 32
weeks of gestation, but can be as early as late mid-trimester.
 More than half of women affected by placenta praevia (51.6)%
have bleeding before delivery.
 This bleeding often starts mildly and may increase as the area
of placental separation increases.
 Placenta praevia should be suspected if there is bleeding after
24 weeks of gestation. Bleeding after delivery occurs in about
22% of those affected.
 Women may also present as a case of failure of engagement of
fetal head.
Cause:-
 The exact cause of placenta previa is unknown.
 It is hypothesized to be related to abnormal vascularisation of
the endometrium caused by scarring or atrophy from previous
trauma, surgery, or infection.
 These factors may reduce differential growth of lower
segment, resulting in less upward shift in placental position as
pregnancy advances.

Risk factors:-
The following have been identified as risk factors for placenta
previa:

 Previous placenta previa (recurrence rate 4–8%) caesarean

delivery, myomectomy or endometrium damage
 Women who are younger than 20 are at higher risk and
women older than 35 are at increasing risk as they get older.
 Alcohol use during pregnancy was previous listed as a risk
factor, but is discredited by this article.
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 Women who have had previous pregnancies (multiparity),
especially a large number of closely spaced pregnancies, are at
higher risk due to uterine damage.
 Smoking during pregnancy cocaine use during pregnancy.
 Women with a large placentae
from twins or erythroblastosis are at higher risk.
 Race is a controversial risk factor, with some studies finding
that people from Asia and Africa are at higher risk and others
finding no difference.
 Placental pathology (velamentous insertion, succenturiate
lobes, bipartite i.e. bilobed placenta etc.)
 Baby is in an unusual position: breech (buttocks first) or
transverse (lying horizontally across the womb).
Placenta previa is itself a risk factor of placenta accreta.

Classification:-
Traditionally, four grades of placenta previa were used, but it is now
more common to simply differentiate between "major" and "minor
cases.

Type Description

Mino Placenta is in lower uterine segment, but the lower edge

r does not cover the internal os

Placenta is in lower uterine segment, and the lower edge

Major
covers the internal os

Other than that placenta previa can be also classified as:

Complete: When the placenta completely covers the cervix

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Partial: When the placenta partially covers the cervix
Marginal: When the placenta ends near the edge of the cervix, about
2 cm from the internal cervical os

Diagnosis:-
 History may reveal antepartum hemorrhage.
 Abdominal examination usually finds the uterus non-tender,
soft and relaxed. 
 Leopold's Maneuvers may find the fetus in an oblique or
breech position or lying transverse as a result of the abnormal
position of the placenta. Malpresentation is found in about
35% cases. 
 Vaginal examination is avoided in known cases of placenta
previa.

Confirmatory:-
Previa can be confirmed with an ultrasound. Transvaginal
ultrasound has superior accuracy as compared to transabdominal
one, thus allowing measurement of distance between placenta and
cervical os. This has rendered traditional classification of placenta
previa obsolete.
False positives may be due to following reasons:-

 Overfilled bladder compressing lower uterine segment

 Myometrial contraction simulating placental tissue in
abnormally low location
 Early pregnancy low position, which in third trimester may be
entirely normal due to differential growth of the uterus.
In such cases, repeat scanning is done after an interval of 15–30
minutes.

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In parts of the world where ultrasound is unavailable, it is not
uncommon to confirm the diagnosis with an examination in the
surgical theatre. The proper timing of an examination in theatre is
important.
If the woman is not bleeding severely she can be managed non-
operatively until the 36th week. By this time the baby's chance of
survival is as good as at full term.

Management:-
 An initial assessment to determine the status of the mother
and fetus is required.
 Although mothers used to be treated in the hospital from the
first bleeding episode until birth, it is now considered safe to
treat placenta previa on an outpatient basis if the fetus is at
less than 30 weeks of gestation, and neither the mother nor the
fetus are in distress.
 Immediate delivery of the fetus may be indicated if the fetus is
mature or if the fetus or mother are in distress.
 Blood volume replacement (to maintain blood pressure) and
blood plasma replacement (to maintain fibrinogen levels) may
be necessary.
 Corticosteroids are indicated at 24–34 weeks gestation, given
the higher risk of premature birth.

Delivery:-
 The method of delivery is determined by clinical state of the
mother, fetus and ultrasound findings. In minor degrees
(traditional grade I and II), vaginal delivery is possible.
  RCOG recommends that the placenta should be at least 2 cm
away from internal os for an attempted vaginal delivery.When
a vaginal delivery is attempted, consultant obstetrician and
anesthetists are present in delivery suite.
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  In cases of fetal distress and major degrees (traditional grade
III and IV) a caesarean section is indicated. Caesarian section is
contraindicated in cases of disseminated intravascular
coagulation. An obstetrician may need to divide the anterior
lying placenta.
 In such cases, blood loss is expected to be high and thus blood
and blood products are always kept ready. In rare cases,
hysterectomy may be required.

COMPLICATION:-
Maternal:-

 Antepartum hemorrhage
 Malpresentation
 Abnormal placentation
 Postpartum hemorrhage
 Placenta previa increases the risk of puerperal
sepsis and postpartum hemorrhage because the lower segment
to which the placenta was attached contracts less well post-
delivery.
Fetal:-

 IUGR (15% incidence)
 Hypoxia
 Premature delivery
 Death

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SUMMARY:-
 Placenta praevia is when the placenta attaches inside
the uterus but in an abnormal position near or over
the cervical opening. Symptoms include vaginal bleeding in the
second half of pregnancy. The bleeding is bright red and tends
not to be associated with pain. Complications may
include placenta accreta, dangerously low blood pressure,
or bleeding after delivery. Complications for the baby may
include fetal growth restriction.
 Risk factors include pregnancy at an older age and smoking as
well as prior cesarean section, labor induction, or termination
of pregnancy. Diagnosis is by ultrasound. It is classified as
a complication of pregnancy.
 For those who are less than 36 weeks pregnant with only a
small amount of bleeding recommendations may include bed
rest and avoiding sexual intercourse.
 For those after 36 weeks of pregnancy or with a significant
amount of bleeding, cesarean section is generally
recommended.
 In those less than 36 weeks pregnant, corticosteroids may be
given to speed development of the baby's lungs.
 Cases that occur in early pregnancy may resolve on their own.
 It affects approximately 0.5% of pregnancies.

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  After four cesarean sections, however, it affects 10% of
pregnanc

BIBLIOGRAPHY:-
 Marlow, textbook of pediatric nursing,6th edition, page no.326-
328.
 D.c dutta, textbook of obstetrics, page no. 241-252
 www.link.in

 WWW.SLIDESHARE.IN

 Management information system: cited on 9 Feb 2013:available

from :http://www.instahealthsolutions.com/modules.htm
 Electronic_medical_record : cited on on 9 Feb 2013:available from
:http://en.wikipedia.org/wiki/Electronic_medical_record
 Management information system: cited on 10 Feb2013: available
from
:http://en.wikipedia.org/wiki/Management_information_system

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