Multiple gestation TypesDegrees o Marginal or low line Placenta that is near

Multiple gestation typesdegrees o marginal or low

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Multiple gestationTypes/DegreesoMarginal or low linePlacenta that is near the os, no problem during delivery-c-sectionoPartial placenta previaProblem because once our cervix opens we’re just going to bleed-csectionoComplete placenta previaPlacent is right in the way of deliverying the baby. How will we have a delivery? C-sectionoFind this incidentally, USSigns/symptoms/assessment oDiagnosed on ultrasound- usually around 20 weeks gestationMay resolve as pregnancy progressesoAssociated with abrupt, painless, bright red bleedingoBleeding usually occurs around end of second trimester into third trimester. 30 weeks oInitial bleeding episodes are usually lightPatient teaching:oon pelvic rest-NOTHING IN THE VAGINA, NO VAGINAL SEX, NO FINGERING,oBleeding precautionsoNEVER PERFORM A VAGINAL EXAM (contraindicated)Nursing actions if she is bleeding:oBedrestoFetal monitoringoMonitoring for contractions and PTLoFrequent assessment of vital signsoIV fluids with 18 G accessoObserve for bleeding-documentation with pad count or quantitative blood loss (QBL)-weigh the wet or saturated pad and then subtract the dry weightoType & cross-matchCord ProlapseoWhat it is?Loop of umbilical cord slips down in front of the presenting part.oS/S: deceleration of FHT: bradycardia, persistent variable decels, cord palpated or seen in vagina
oAssociated with:Premature rupture of membranesTransverse or breech presentationMultiple gestationPlacenta previaHydramnios- usually polyhydramniosCPD (non-engagement of fetal head) oWhat causes it (or who causes it when they try to rupture the bag of water before the fetal head is engaged in the pelvis)The head should be engaged-don’t break the bag of wateroInterventions and nursing careIf you see cord out- put your fingers in the vagina and lift the head or presenting part, up off the cord so that’s not occluded.Once you have lifted the head you’re stuck!!!**** NEED TO RECOGNIZE THIS IS AN EMERGENCY****oManagement: Holdfetal head off cord so its no occluded, Trendelenburg or knee/chest position, immediate emergency c-sectionoPreventionWatch fetal heart tones after rupture of membranes (SROM or AROM). Do VE if any sign of fetal distress.If head not engaged, women with ruptured membranes should not ambulate. oVisual findings if cord has prolapsed out of the vagina versus palpable findings on vaginal exam- you either feel it or see itPlacenta Accreta:oAn abnormality of placental implantation defined by degrees of invasion into uterine walloAccreta: beyond normal boundary, grows into the walloIncreta: extends into uterine myometrium, grows thru the walloPercreta: extends into uterine musculature and can adhere to other pelvic organs, grows into other organs usually the bladderoCan be diagnosed on ultrasound during prenatal course, or diagnose it during delivery.

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