PLACENTAL PROBLEMS

Question 1

• An implantation of the placenta in the lower uterine segment.
• Cause is unknown but is thought to occur whenever the placenta is forced to spread to find an adequate exchange surface.

Answer 1

placenta previa

Question 2

risk factors of placenta previa

Answer 2

• hx of previa
• multiparity
• increasing age
• large placenta
• smoking and cocaine use
• previous CS
• uterine surgery
• abortion
• multiple gestation
• male fetus

Question 3

Placenta completely covers the internal cervical OS

Answer 3

total placenta previa

Question 4

Placenta partly covers the cervical opening but does not completely cover the OS.

Answer 4

partial placenta previa

Question 5

Placenta edge reaches within 2 to 3 cm of the cervical opening

Answer 5

marginal placenta previa

Question 6

Placenta is implanted in the lower uterine segment near the cervix but does not cover the internal cervical OS

Answer 6

low lying placenta previa

Question 7

s/sx of previa

Answer 7

• painless uterine
• bright red bleeding
• soft, relaxed nontender uterus
• fundal height > age
• unengaged presenting part

Question 8

done to see the location and position of placenta

Answer 8

transabdominal ultrasound

Question 9

if the mother is stable & the fetus is immature and has reassuring status = ??

Answer 9

delay birth, administer betamethasone, observe bed rest

Question 10

Ultrasonographic examination may be done every ___ weeks

Answer 10

2-3 weeks

Question 11

Fetal surveillance – ___ and ___ once or twice a week

Answer 11

NST and BPP

Question 12

true or false - you can do vaginal or
rectal examinations during previa

Answer 12

false

Question 13

if woman is at term = ??

Answer 13

CS delivery is almost always indicated

Question 14

true or false - In women who have minimal bleeding, vaginal birth may be attempted

Answer 14

true

Question 15

complications of previa

Answer 15

• prom
• hemorrhage
• preterm labor

Question 16

• premature separation of a normally implanted placenta from the uterine wall before the fetus is born
• Occurs in cases of bleeding and formation of hematoma(clot) on maternal side of the placenta

Answer 16

abruptio placenta

Question 17

risk factors of abruptio

Answer 17

• cocaine
• HTN
• smoking
• multigravida
• hydramnios
• increased maternal age
• abd trauma
• PPROM
• chorioamnionitis
• alcohol
• domestic violence
• short cord
• thrombophilia

Question 18

bleeding formation of hematoma > ___ of hematoma > ____ of placenta

Answer 18

expansion; separation

Question 19

abruptio: Major dangers for the woman:

Answer 19

hemorrhage, hypovolemic shock, clotting abnormalities

Question 20

abruptio: Major dangers for the fetus:

Answer 20

asphyxia, blood loss, prematurity

Question 21

when the placenta doesn’t completely detach from the uterine wall

Answer 21

partial abruptio placenta

Question 22

when the placenta completely detaches from the uterine wall

Answer 22

complete abruptio placenta

Question 23

when the placenta detaches from the uterine wall, starting from its central portion

Answer 23

central abruption placenta

Question 24

• Uterus turns entirely blue because the muscle fibers are filled with blood
• Uterus contracts poorly after birth
• Necessitates hysterectomy

Answer 24

couvelaire uterus

Question 25

s/sx of couvelaire uterus

Answer 25

- dark red bleeding - rigid uterus - sharp, stabbing pain in the fundus - low intensity contractions - abd or low back pain

Question 26

goal in abruptio placenta

Answer 26

pt will exhibit signs of increased blood volume and restoration of cardiac output

Question 27

early signs of hypovolemic shock

Answer 27

- fetal and maternal tachycardia - decreased BP - increased RR - cool, pale skin and mucous membranes

Question 28

late signs of abruptio

Answer 28

- falling BP - pallor, cold and clammy - UO < 30 ml/hr - restlessness, agitation

Question 29

how to promote tissue oxygenation

Answer 29

- o2 support - lateral position - head FOB - limit activity

Question 30

a serious pregnancy condition that occurs when blood vessels & other parts of the placenta grow too deeply into the uterine wall

Answer 30

placenta accreta

Question 31

placenta adhered to myometrium with no intervening decidua

Answer 31

placenta accreta

Question 32

placenta is within the myometrium

Answer 32

placenta increta

Question 33

placental tissue is extrauterine or on the uterine serosa

Answer 33

placenta perceta

Question 34

causes of accreta

Answer 34

- abnormalities in the uterus lining - hx of CS delivery

Question 35

risk factors of accreta

Answer 35

- previous uterine surgery - placenta position - maternal age - previous childbirth - uterine conditions - presence of tumor

Question 36

s/sx of accreta

Answer 36

- vaginal bleeding during the 3rd trimester (27-40 wks) - massive bleeding during labor and delivery

Question 37

imaging test for accreta

Answer 37

ultrasound and MRI

Question 38

blood test for accreta

Answer 38

alpha-fetoprotein

Question 39

management for accreta

Answer 39

- placenta is left in the uterus - cord ligated - closure of the uterus - methotrexate - prophylactic antibiotic

Question 40

surgical management for accreta

Answer 40

cesarean, hysterectomy

Question 41

in a ___ hysterectomy, hormones decrease because the ovaries are removed, which results in ___

Answer 41

radical; hot flashes

Question 42

for clients taking methotrexate, instruct to?

Answer 42

increase OFI to at least 2L per day

Question 43

complications of accreta

Answer 43

- uterine rupture - heavy vaginal bleeding - premature birth - disseminated intravascular coagulation

Question 44

true or false - placenta accreta can be prevented by avoiding the risk factors

Answer 44

false - there is no way to prevent placenta accreta