5. Compare and contrast the assessment parameters found with PLACENTA PREVIA and ABRUPTO PLACENTA.

Differentiate the plans of care and evaluating out comes.

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Bleeding may occur at various times in pregnancy. Although bleeding is alarming, it may or may not be a serious complication. The time of bleeding in the pregnancy, the amount, and whether or not there is pain may vary depending on the cause. Placenta previa and placenta abruptio are both conditions associated with pregnancy and childbirth. Both placenta previa and placenta abruptio have the potential to cause severe health risks to both mother and baby, including severe blood loss. When caught in time, they are treatable conditions if diagnosed properly. Placenta previa is a condition that develops early in pregnancy, and placenta abruptio is a condition that develops at the end of pregnancy.

Differences Between Placenta Previa and Placenta Abruptio

Placenta previa is a condition that occurs when the placenta is not attached high enough in the uterus. There are three types of placenta previa. When a pregnant women has total placenta previa, the placenta covers her entire cervix. In partial placenta previa, the placenta covers only some of the cervix. In marginal placenta previa, the placenta does not cover any portion of the cervix, but it's located very close to the edge.

Unlike placenta previa cases which develop early in pregnancy, abruptio placenta usually occurs in the last trimester. Placental abruption is the premature separation of a placenta from its implantation in the uterus. Within the placenta are many blood vessels that allow the transfer of nutrients to the fetus from the mother. If the placenta begins to detach during pregnancy, there is bleeding from these vessels. The larger the area that detaches, the greater the amount of bleeding. Placental abruption occurs about once in every 120 births. It is also called abruptio placenta.

Causes
Placenta previa is not caused by environmental factors. Typical causes for placenta previa include uterine scars, a placenta that is larger than average or a uterus that is abnormally shaped. Placenta abruptio can occur for natural reasons such as uterine distension, diabetes or high blood pressure. Unlike placenta previa, abruption placenta can be caused by environmental factors. Placenta abruptio can be caused by smoking, drinking or drug use during pregnancy.

Symptoms
The most common symptom of placenta previa is vaginal bleeding that is bright red and not associated with abdominal tenderness or pain, especially in the third trimester of pregnancy. However, each woman may exhibit different symptoms of the condition or symptoms may resemble other conditions or medical problems. The most common symptom of placental abruption is dark red vaginal bleeding with pain during the third trimester of pregnancy. It also can occur during labor. However, each woman may experience symptoms differently.

Diagnosis
Placenta previa is easily diagnosed by an ultrasound. Doctors are able to tell the position of the placenta using this diagnostic tool. An ultrasound can also be used to diagnose placenta abruptio, but the condition is not always detected by this test. If placenta abruptio is suspected, a doctor may also perform tests and a pelvic exam to see how well the the mother's blood is clotting. How is placenta previa diagnosed? In addition to a complete medical history and physical examination, an ultrasound (a test using sound waves to create a picture of internal structures) may be used to diagnose placenta previa. An ultrasound can show the location of the placenta and how much is covering the cervix. A vaginal ultrasound may be more accurate in diagnosis. Although ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta previa. It is common for the placenta to move upwards and away from the cervix as the uterus grows, called placental migration. The diagnosis of abruptio placenta is usually made by the symptoms, and the amount of bleeding and pain. Ultrasound may also be used to show the location of the bleeding and to check the fetus.

There are three grades of placental abruption, including the following:

Grade 1 - small amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood pressure in the mother. Grade 2 - mild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of distress. Grade 3 - moderate to severe bleeding or concealed (hidden) bleeding, uterine contractions that do not relax (called tetany), abdominal pain, low blood pressure, fetal death.

Sometimes placental abruption is not diagnosed until after delivery, when an area of clotted blood is found behind the placenta.

Why is placenta previa and abruption placenta a concern?

The greatest risk of placenta previa is bleeding (or hemorrhage). Bleeding often occurs as the lower part of the uterus thins during the third trimester of pregnancy in preparation for labor. This causes the area of the placenta over the cervix to bleed. The more of the placenta that covers the cervical os, the greater the risk for bleeding. Other risks include the following:

abnormal implantation of the placenta. slowed fetal growth. preterm birth.

birth defects. infection after delivery.

Placental abruption is dangerous because of the risk of uncontrolled bleeding (hemorrhage). Although severe placental abruption is rare, other complications may include the following:

hemorrhage and shock. disseminated vascular coagulation (DIC) - a serious blood clotting complication. poor blood flow and damage to kidneys or brain. stillbirth. postpartum (after delivery) hemorrhage.

Treatment
Treatment for placenta previa depends on the severity of the condition. Bed rest is required when a woman experiences bleeding. Severe bleeding can require a woman to be hospitalized and monitored. A C-section is typically chosen over a vaginal birth in a woman with placenta previa when a baby is full term. If the mother or baby is experiencing severe distress, the baby may have to be delivered earlier than planned. There is no treatment to change the position of the placenta. Once placenta previa is diagnosed, additional ultrasound examinations are often performed to track its location. It may be necessary to deliver the baby, depending on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is necessary for most cases of placenta previa. Severe blood loss may require a blood transfusion. Nursing Management 1. Ensure the physiologic well-being of the client and fetus a. Take and record vital signs, assess bleeding, and maintain a perineal pad count. Weigh perineal pads before and after use to estimate blood loss. b. Observe for shock, which is characterized by a rapid pulse, pallor, cold moist skin and a drop in blood pressure c. Monitor the FHR d. Enforce strict bed rest to minimize risk to the fetus e. Observe for additional bleeding episodes. 2. Provide client and family teaching a. Explain the condition and management options. To ensure an adequate blood supply to the mother and fetus, place the woman at bed rest in a side-lying position. Anticipate the order for a sonogram to localize the placenta. If the condition of mother or fetus deteriorates, a cesarean birth will be required. b. Prepare the client for ambulation and discharge ( may be within 48 hours of last bleeding episode) c. Discuss the need to have transportation to the hospital available at all times. d. Instruct the client to return to the hospital if bleeding recurs and to avoid intercourse until after the birth. e. Instruct the client on proper handwashing and toileting to prevent infection.

3. Address emotional and psychosocial needs a. Offer emotional support to facilitate the grieving process, if needed b. After birth of the newborn, provide frequent visits with the newborn so that the mother can be certain of the infants condition Treatment for abruptio placenta usually must occur rapidly. If the condition occurs before the baby is fully developed, a mother may be given fluids and blood transfusions. She will then be monitored until the baby can be safely delivered. Sometimes placenta abruptio will threaten the life of a mother and child, and an emergency cesarean section may be done as quickly as possible, even if it means the baby will be born premature. If the uterine bleeding caused by placenta abruptio cannot be stopped, a hysterectomy will be performed. There is no treatment to stop placental abruption or reattach the placenta. Once placental abruption is diagnosed, a woman's care depends on the amount of bleeding, the gestational age, and condition of the fetus. Cesarean delivery is performed for most cases of placental abruption and emergency delivery may be needed if hemorrhage occurs. Severe blood loss may require a blood transfusion.

Nursing Management: 1. Continuous evaluate maternal and fetal physiologic status, particularly: o Vital Signs o Bleeding o Electronic fetal and maternal monitoring tracings o Signs of shock rapid pulse, cold and moist skin, decrease in blood pressure o Decreasing urine output o Never perform a vaginal or rectal examination or take any action that would stimulate uterine activity. 2. Asses the need for immediate delivery. If the client is in active labor and bleeding cannot be stopped with bed rest, emergency cesarean delivery may be indicated. 3. Provide appropriate management. o On admission, place the woman on bed rest in a lateral position to prevent pressure on the vena cava. o Insert a large gauge intravenous catheter into a large vein for fluid replacement. Obtain a blood sample for fibrinogen level. o Monitor the FHR externally and measure maternal vital signs every 5 to 15 minutes. Administer oxygen to the mother by mask. o Prepare for cesarean section, which is the method of choice for the birth 4. Provide client and family teaching. 5. Address emotional and psychosocial needs. Outcome for the mother and fetus depends on the extent of the separation, amount of fetal hypoxia and amount of bleeding.

Summary between Placenta Previa and Abruption Placenta

CATEGORY
Problem Incidence

Placenta Previa
Low implantation of the placenta It occurs in approximately 5 in every 1000 pregnancies Always present Bright red Painless
Bed rest (side lying position) NO vaginal or pelvic

Abruptio Placenta
Premature separation of the placenta It occurs in about 10% of pregnancies and is the most common cause of perinatal death. May or may not be present Dark red Sharp, stabbing pain

Bleeding Color of blood in bleeding episodes Pain during bleeding Management

examinations Assessment of FHR and bleeding Lateral position No vaginal or pelvic examinations Termination of pregnancy