Abruptio Placentae vs Placenta Previa Nursing NCLEX Symptoms Causes Management (Placental Abruption)

this is cereth registered nurse orion calm and in this video i want to be doing a quick review over abruptio placentae versus placenta previa now in the previous videos we did an in-depth discussion about these two conditions so if you haven't watched those videos be sure to check those out and as always at the end of this youtube video you can take the free quiz that will test you on these conditions so let's get started first I'll start out talking about abruptio placentae okay this is a detachment issue so we have had detachment of this placenta prematurely before the baby is born because when does the placenta normally remove itself from the uterine wall after the birth of the baby because the placenta maintains the pregnancy it delivers oxygen and nutrients and removes waste from the baby via that umbilical cord so once that baby's born it doesn't need the placenta anymore it has mama but while it is still in the uterus it needs the placenta so the placenta can come off of the uterine wall and you can have different types of abruptio placentae such as partial abruption where it's partially came off the wall or total where it's completely removed itself from the wall now let's take a look at placenta previa okay this is an attachment issue so that placenta hasn't attached where it's supposed to like it's supposed to attach in the top part of the uterus or the side instead it's decided to attach somewhere low in the uterus usually over that cervical opening and we don't want that because there's issues with the placenta becoming damaged and it can bleed hemorrhage which will cause issues for Mama and baby and you have different types of placenta previa you can have partial where this placenta is partially covering the cervical opening or you can have marginal where the placenta is low wide and it's at the edge of the cervical opening or you can have total like which is demonstrated in this drawing here where the placenta is completely covering the cervical opening and now let's look at the causes what could cause abruptio placentae well this condition typically occurs in the third trimester so with moms what pressure is not being controlled she has chronic hypertension it can lead to this also the development of preeclampsia or they've had a history of having an abruption in the past or they've experienced premature rupture of the membranes they use cocaine they smoke cigarettes or they're carrying more than one baby like twins or triplets they've been pregnant a lot of times before or they've experienced some type of trauma to the abdomen that has caused that placenta to detach itself okay causes a placenta praevia advanced maternal age greater than 35 or older or they've experienced scarring in the uterus due to surgery like the removal of fibroids or c-section also carrying more than one child can cause that as well like twins or triplets they've already had a baby in the past or they use cocaine or smoked cigarettes now let's talk about the signs and the symptoms that you can see in each of these conditions and as I go over them really commit to memory those differences because that is where exams love to ask you questions okay so to help us remember abruptio placentae let's remember the mnemonic and the word detach and to help us remember placenta previa signs and symptoms let's remember the word previa okay so first let's talk about abruptio placentae okay d4 dark red bleeding here a lot of times in abruptio placentae it can be concealed where the blood is just not readily there where you can see it so by the time it does come into the vaginal area it will be dark in color and then e4 extended fundal height and again this is from the concealed bleeding if it stays within the uterus the uterus can increase in height and that fundal height will increase and then t4 tender uterus a for abdominal pain slash contractions the patient may complain of this and then see for the concealed bleeding and this bleeding can stay or backflow within the uterus or the abdomen and the patient can enter shock without you even seen lots of amounts of blood being lost as you would in placenta previa and then H for hard abdomen be rigid and then e for experienced di C disseminated intravascular coagulation and if the placenta is not delivered promptly after that detachment this can really occur and what happens when this placenta detaches itself it's damaged and it can release large amounts of thromboplastin into mom circulation which is going to send off this massive Claudine event throughout the body where she has little micro embolisms forming in the blood which is going to block blood vessels hence blood flow and it can affect major organs like your brain your kidneys lungs things like that well the body will sense this major Claudine event going on so it tries to help it so it causes fibrinolysis to happen hoping to break down that fibrin in those clots to break up those clots and prevent that but while all this is going on those Claudine factors those clotting sores are being depleted so mom doesn't have anything to stop bleeding and that's a big problem because from where this placenta has came off the uterine wall it's left a fresh open wound in there and that wound isn't going to like clot and have a band-aid over it to prevent so much blood loss so it's just gonna bleed and bleed and she could also bleed in other areas of her body like gums the IV sites things like that so you really have to watch out for di C with this condition the last part of our mnemonic the D for distress baby the baby can experience heart rate abnormalities and again this is because the placenta has lost its effectiveness it's attached from the uterine wall it's not working properly so baby can start becoming unstable now let's look at Plus into preview okay P for painless vaginal red bleeding this can be mild to Protea placentae also are for relaxed soft non-tender uterus it won't be hard and rigid like in the other condition and then II episodes of bleeding not spotting and this again is most likely going to occur during the third trimester and as the body prepares for the baby with the cervix thinny and it causes bleeding from where it's tearing the vessels in the placenta so that's why and when mom will start noticing this bright red bleeding and then v4 visible bleeding not concealed as in some cases with abruptio placentae so you're gonna see that blood and then i intercourse post bleeding where after sexual intercourse they will have bleeding and that's because right at the cervix is that placenta and this can be spontaneous or occur during labor and then a for abnormal fetal position the baby can be breached as you can see here with the bottom first or they can be transverse live where they're like lying sideways and why is that well it's because the placenta is down here and this is where baby's head should be the baby's head really can't go there since the placenta is in the way so you're gonna see an abnormal fetal position in this then compared to this condition over here and the baby's heart rate tends to be normal because we don't have like a lot of damage going on to the placenta like you did over here in abruptio placentae where fetal distress is going to be a lot more common now let's take a look at nursing interventions okay if one of these conditions is suspected or actually presenting there will be no vaginal exams or abdominal manipulation because that can make things worse and they can take an ultrasound and they can assess what is going on and one thing I'd like to point out about placenta previa is that a lot of times as diagnosed at the 20-week ultrasound they can look at the placenta see where it's at and if it's marginal like low lying down on the bottom they will monitor that because as the uterus grows and expands that placenta can move upward alleviating that plus into previous so it's not over the cervical opening and they'll relook at that at the 32 week ultrasound but usually if it's completely covering that cervical opening like here it's usually not going to move up and they'll have to really monitor them so keep that in mind now with both conditions there is a risk of hemorrhage over here and placenta previa it's going to be visible and over here in abruptio placentae it can be concealed or visible so keep that in mind and since it could possibly be concealed over here and abruptio placentae you want to measure and Mark that fundal height and measure the abdominal girth and you'll both conditions the doctor will order type and cross-match in case they need blood you'll need to get IV access a CBC looking at all those levels clotting levels what's their Rh factor if they're negative they'll need rhogam and monitoring those vital signs every 15 minutes or whatever your protocol is at your hospital monitoring for signs of shock external monitoring of the baby making sure baby is not in distress you don't want to use internal and remember which conditions going to possibly there's an increased risk of fetal distress over here with abruptio placentae because that placenta has came off of that uterus wall and it's not supposed to do that and it decreases its ability to function properly so you go to watch for that and a pad count especially with previa or a linen count see how much is coming out of the vaginal area how much blood are they losing because you can typically see it since it's visible and then side laying positions best because that increases the left side line increases perfusion to the uterus and with this over here abruptio placentae you want to monitor 4d I see semmen ated intravascular coagulation so look at those lab levels how are their platelets are they decreasing the fibrin Jim is it decreasing per thrown Bowden time is it decreasing gum bleeding look at those gums you see the leading that's not a good sign or easing especially at injection sites or IV sites you just see a little bit of blood just trickling out and just oozing around the site that's a red flag or petechiae this is where you have broken capillary blood vessels for ecchymosis and monitoring for those micro emboli where those little clots have got in the blood vessels and are stopping perfusion so you could see Miro changes if it's with the brain chest pain or shortness of breath if it's in the heart or the lungs or a decrease urinary output if it has affected the kidneys and eat all these cases are really the treatment depends on how far along mom is how severe it is is it complete is it partial either one of these and what's going to happen and what the doctor is going to order but always be prepared for delivery if need be mom's unstable this is a total previa things aren't going good or a total abruption probably emergency c-section is where they will be going okay so that wraps up this review over these two conditions thank you so much for watching don't forget to take the free quiz 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Channel: RegisteredNurseRN

Views: 577,600

Keywords: abruptio placentae, abruptio placentae vs placenta previa, abruptio placentae nursing, abruptio placentae nclex, placental abruption, placental abruption vs previa, placental abruption vs placenta previa, placenta previa, placenta previa vs abruptio, placenta previa nursing, placenta previa symptoms, placenta previa and abruptio placentae, placenta previa and placental abruption, placenta previa and abruption difference, placenta previa and abruptio placentae difference

Id: FDRSPppWe2k

Length: 12min 28sec (748 seconds)

Published: Mon Feb 05 2018