Maternity Test 3 - PlacentaPrevia . , RiskFactors Multipar

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ANTEPARTAL COMPLICATIONS Placenta Previa The placenta is improperly implanted in the lower uterine segment. As the lower uterine segment  contracts in the later weeks of pregnancy, the placental villi are torn from the uterine wall Occurs in the last 3-4 months of pregnancy  Risk Factors Multiparas * Previous uterine surgery * Multiple pregnancy Previous previa Smoking Elective abortion Types Complete Placenta Previa o Internal os is covered completely by placenta, centrally located over the cervix o Cannot deliver vaginally- placenta will pop out when baby pops out o Risk of profound hemorrhage  Partial Placenta Previa o Placenta is within 3 cm of internal os of the cervix o Can hemorrhage significantly in labor if try to deliver vaginally o Deliver by CS Marginal/Low lying Placenta Previa o Placenta reaches cervix or is more than 3 cm from internal cervical os o Might not bleed until labor o Might deliver vaginally CM Might not bleed until labor begins Bleeding is inevitable as placenta separates from uterine wall Intermittent painless bleeding      is the best diagnostic sign, can be bright red or dark, trickles or  gushes of blood Uterus is soft and non-tender  Management Diagnosis by Ultrasound NO vaginal exams until diagnosis, after you know-no vaginal exams either Massive hemorrhage can occur, have blood ready for transfusion IV line if bleeding Bedrest – no enemas or sex Monitor VS, FHR, contractions Deliver when baby’s lungs are mature Complications Massive hemorrhage
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Emergency CS Infection Anemia Postpartal hemorrhage- area where it is implanted has no muscle fiber so it can increase the  bleeding Abruptio Placenta Premature separation of a normally implanted placenta from the uterine wall May not be diagnosed until after delivery if minor  Cause Largely unknown – thought its related to decreased bf to the placenta through the sinuses during  the last trimester.  Multiparicy/ multiple pregnancy Hypertension Previous abruption Abdominal trauma- domestic abuse Smoking/cocaine use – powerful vasodilator CM Bleeding is concealed or not apparent or a combination of both Large clot may be formed behind the placenta- will cause irritability Tender, painful, irritable uterus because of the clot Rigid board like uterus  Hypertonic labor pattern Complications Massive hemorrhage can lead to hemorrhagic shock Development of DIC: disseminated intravascular coagulation- as a result to the uterine damage to 
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