Abruptio placenta, Placenta

previa, Premature rupture of

membrane (PROM)
 Abruptio Placenta vs. Placenta previa
• Low implantation of placenta
• Premature separation 4 types:

of the placenta • Low-lying placenta

– implantation in lower rather than upper

• Most frequent cause portion of the uterus

• Marginal implantation
of perinatal death – placenta edge approaches that of the cervical
os
2 Types: • Partial placenta previa
1. Complete – Implantation occludes a
cervical os
portion of the

2. Partial • Total / Complete placenta previa

– implantation that totally obstructs the cervical os
 Abruptio Placenta vs. Placenta previa

Causes: Causes:
• Advanced maternal age
• Advanced maternal
• Past caesarean births
age
• Past uterine curettage
• Short umbilical cord • Multiple gestation
• Chronic hypertensive • Asian women
disease • Previous miscarriage
• Previous induced abortion
• Pregnancy-induced
• Cigarette smoking
hypertension
• Direct trauma
 Abruptio Placenta vs. Placenta previa
Signs & symptoms Signs/Symptoms
- Heavy bleeding - Painless bleeding
- Extended fundal height - Relaxed soft non-tender
- Tender uterus uterus
- Abdominal - Episodes of bleeding
pain/contractions - Visible bleeding
- Concealed bleeding - Intercourse post bleeding
- Hard abdomen - Abnormal fetal position
- DIC
 Abruptio Placenta vs. Placenta previa
Nsg. Intervention Nsg. Intervention
- No vaginal examinations done for - Place the woman immediately on bed rest
in a side-lying position
both
- Begin IVF therapy using large-gauge
- Assess bleeding catheter
- Record maternal vital signs every - Monitor urine output frequently (every
5-15 minutes hour)
- Position - Oxygen equipment available
- Fluid replacement (IV therapy) - Obtain baseline vital signs
- Oxygen inhalation through mask - Assess for bleeding
-Monitor FHT
- Hemoglobin, Hematocrit, Prothrombin
-IV administration of fibrinogen or
time, Partial thromboplastin time,
cryoprecipitate Fibrinogen, Platelet count, Type and
-Assess for signs of shock (for both) cross-match, Antibody screen (for both)
 Abruptio Placenta vs. Placenta previa
Complications:
Complications:
- Prone to PP hemorrhage
- Fetal maternal
– Placental site at lower
hemorrhage uterine segment X contract
-Couvelaire uterus as efficiently as upper
-Maternal mortality uterine segment

-Hypovolemic shock - Prone to endometritis

-Renal failure – Placental site close to
-DIC cervix
-Rh sensitization - Placenta larger
– ↓ uterine BF
PRETERM RUPTURE
OF MEMBRANES
 Preterm Rupture of Membranes
before 37 weeks
↓
rupture of fetal membranes
↓
loss of amniotic fluid during pregnancy

• 5% to 10% of pregnancies
 Risk factors
• Unknown • UTI
• Chorioamnionitis / • Amniocentesis
Endometritis • PP
• Low socio-economic • AP
status
• Trauma
• Tobacco use
• Incompetent cervix
• Low BMI
• Bleeding during pregnancy
• Previous hx of PROM
• Maternal genital tract
• Hydramnios anomalies
• Multiple pregnancy
 Sign
• Sudden gush of clear fluid
from the vagina with
continued minimal leakage
 Maternal complications
rupture of membranes
↓

Preterm labor
↓

END pregnancy
• AP
• Retained placenta
• Hemorrhage
• Maternal sepsis
• Maternal death
 Fetal complications
Rupture early in pregnancy
↓

X seal to the fetus

↓

Uterine and fetal infection

-----------------------------------------------------------------------------------------------
Loss of amniotic fluid
↓

↑ pressure on umbilical cord

↓

Interfere with fetal circulation

↓

X fetal nutrient supply + cord prolapse

 complications
Non-fluid-filled environment
↓

distorted facial features + pulmonary hypoplasia (pressure)

↓

Potter-like syndrome
• RDS (respiratory distress syndrome)
• Malpresentation
 Assessment:
• Pooling of fluid at vagina
– Sterile vaginal speculum examination
• Vaginal infection
– Different from urine by appearance – Neisseria
• Nitrazine paper test gonorrhoeae
– Blue
– Yellow – streptococcus B
• Ferning test under microscope – Chlamydia
– (+) ferning (estrogen) probable PROM

– (-) ferning
• ↑ level of AFP in the vagina • ↑ WBC and C-
reactive protein
 Therapeutic Management:
• bed rest (hospital / home)

• Corticosteroid
– Betamethasone
– Deep IM
– 12mg ODx2 days;6mg q 12 hoursx4 doses
– RDS, intraventricular hemorrhage, necrotizing enterocolitis

• Broadspectrum antibiotic
– ↓risk of infection in NB
– delay onset of labor
– sufficiently allow corticosteroid to have its effect
• IV administration of penicillin or ampicillin
– streptococcus B
 Therapeutic Management:
membranes can be resealed
↓

fibrin-based commercial sealant

↓

to maintain intact membranes

↓

DISADVANTAGE: future possibility for premature rupture of the

membranes

• IV administration of oxytocin at time of rupture

– to stimulate labor
– fetus is estimated to be mature enough to survive in an extrauterine
environment
– fetus is born before infection can occur
 Nursing Management:
Nursing Interventions:
• X routine vaginal examination
• Left-side lying position

• At home:
– √ fever 2x/day (T= ↑ 38°C)
– √ uterine tenderness
– √ odorous vaginal discharge
– X tub bathing, douching, and coitus

• Daily assessment of WBC

– ↑ 18,000 to 20,000/mm3
– Infection

• Provision of emotional support

– NO DRY LABOR!