Ante Partum Bleeding – Suspect Placenta previa ~ BLEEDING
1. Understanding
a. Ante Partum Bleeding (APB) / ante partum bleeding is bleeding that occurs after 28 weeks of pregnancy.
Usually, more and more dangerous than the bleeding before the 28th week of pregnancy. Classification APB
- Sourced from abnormal placenta
Palcentra previa
Placenta Solutio
APB is not yet clear source; insersio velamentosa roptum sinus marginalis, placenta Chain vakita
- No abnormalities derived from placenta, usually not very dangerous, for example, cervical and vaginal abnormalities (polyps, erosio, a ruptured varicose veins), and trauma.
b. Placenta Previa is a condition in which abnormal placenta implantation in place ie the lower segment of the uterus, thus covering part or all of the opening of roads and internal os uteri (GUI)
Classification Placenta Previa, which would not agree, because the division was not based on anatomical situation but the situation has changed fiosiologik-fox. Classification consists of;
- Palcenta previa centralist / Totalis; if at the opening of 4-5 cm palpable cover selutuh ostea placenta.
- Palcenta previa lateralis; when 4-5 cm in the opening portion is covered by placenta.
Posterior lateral Palcenta previa; when partially covered rear ostea. Anterior lateral Palcenta previa; when some ostea front cover.
Palcenta previa marginalis; if a small / only the edge of the placenta covered ostea
Classification according to the U.S. Book
– Palcenta previa Totalis; when all ostea covered by the placenta
- Palcenta previa partialis; when partially covered by placenta ostea
- Palcenta lies low / low lying placenta; when the edge of placenta was 3-4 cm above the edge of the opening. At check in was not palpable.
Classification according to Browne
- Level 1: Lateral palcenta previa, when the bottom edge of palcenta inserts to the SBR, but not up to the edge of the opening
- Level 2: palcenta marginal previa, when the placenta reaches the edge of the opening ostea
- Level 3: palcenta complete previa, when the placenta covers ostea closed time, and does not cover when the opening is almost complete.
- Level 4: central placenta previa: when the placenta covers the opening almost entirely on .
2. Aetiology
The exact cause is not known clearly. These factors put forward:
a. The endometrium is inferior
b. The leaves are persistent chorion
c. corpus luteum which reacts slowly
Strassman said that the most important factor is the lack of decidua vasfolarisasi ~ atrophy and inflammation
3. Aetiology Factors
a. Age and parity
- In the primigravida aged> 35 years more frequently than age <25 years
- At multipora more often
b. Endometrium hipoplastis: married and pregnant young age.
c. Endometrium unblemished in the former repetitive labor, the former surgery, curettage, and manual placenta.
d. Corpus luteum slow to react, in which the endometrium is not ready to receive the products of conception.
e. The existence of a tumor; myoma uteri, endometrial polyps.
f. Sometimes in malnutrition
4. Diagnosis and clinical picture
a. Anamneses
- The first symptom; bleeding in pregnancy after 28 weeks / third trimester
- Nature of bleeding; without cause, without pain, recurrent
- For bleeding, placenta and blood vessels that are torn; formation of SBR, the opening osteum / intravaginal / rectal.
- A little amount of bleeding, depending on how big or small tear and blood vessels
placenta. b. Inspection
- It can be seen a lot or a little vaginal bleeding.
- If bleeding more; mother looked anemic.
c. Abdominal Palpation
- The fetus is often not enough months; TFU is still low.
- Often found fault location
- The bottom of the fetus has not dropped, if the position of the head is usually the head still
rocking / floating.
5. Effect of pregnancy Placenta Previa
a. Because the placenta is disturbed by the lowest part of the fetus can not enter the PAP. Location errors; location sunsang, where the latitude, the position of the head afloat.
b. Often premature delivery; stimulation on cervical blood coagulum, if many of placenta
progesterone levels decreased loose and His can occur, an internal inspection.
6. Effect of Placenta Previa on parturition
a. Location of abnormal fetal yan; parturition would be a pathological
b. If the placenta previa lateralis; membrane rupture / prolapse can occur funkuli solved
c. Often some primary insertion d. Bleeding.
7. Complication Placenta Previa
Prolapsed umbilical cord, prolapsed placenta, so it must be manually attached pacenta and if necessary
kerokan cleaned, ripped the birth canal because of the action, post partum hemorrhage, infection due to bleeding, premature babies / stillbirth.
8. Handling (passive)
a. Each bleeding the third quarter more than the show should be immediately sent to hospital without
conducted a manipulation / UT.
b. If the bleeding a little, the fetus was still alive, yet inpartus, not quite 37 weeks of pregnancy / fetal weight less than 2500 grams birth can be delayed with rest, medication; spasmolitik, progestin / progesterone, meticulous observation.
c. Prepare blood for blood transfusions, pregnancy is maintained as old as possible so as not to prematurely
d. If there is anemia, transfusion and blood enhancer drugs.
Nursing Issues: Problems Collaboration:
§ Lack of fluids - Lack of fluids
§ Fetal distress
§ Potential shock occurs
§ Impaired ADL
§ Anxious
Diagnostic Examination:
§ Complete blood count, ultrasound
§ Results: Hb: 9.6 PVC: 30.0 Trombosyt: 243 000
§ Ultrasound Results: There was fetal T / H position latitude, head of BPD = 83.5 according to 33 weeks of pregnancy, Placenta at SBR rear extends to cover the internal uterine Osteum Grade II
Nursing Diagnosis:
1. Risks associated with the fluid deficiency bleeding.
2. Risk of fetal distress occurred in connection with abnormal location of the placenta.
3. Potential happen hypovolemic shock associated with the bleeding.
4. Disturbance of personal hygiene needs in connection with their activity limited.
5. Disorders of psychological anxiety in connection with the lack of knowledge about a troubled pregnancy.
Intervention:
Dx 1: Risk of lack of fluid in relation to the bleeding.
a. Kaji about the amount of expenditure caiaran (bleeding). b. Observation of the signs vital.
c. Observation of the signs of lack of fluids and monitor the bleeding.
d. Monitor blood electrolyte levels.
e. Check your blood type for transfusion anticipation.
f. Explain to the client to maintain the entrance with plenty of fluids to drink.
g. Collaboration with physicians in relation to the location of the placenta.
Dx 2: Risk of fetal distress occurred in connection with abnormal location of the placenta.
a. Observation of vital signs.
b. Bleeding and monitor the status of the fetus. c. Maintain hydration.
d. Keep tirah lying.
e. Prepare for caesaria section.
Dx 3: Potential happen hypovolemic shock associated with the bleeding.
a. Observation of signs of shock hipolemik.
b. about the amount of drainage (bleeding).
c. Observation of vital signs.
d. Observation of the signs of lack of fluids and monitor the bleeding.
e. Monitor blood electrolyte levels.
f. Check your blood type for transfusion anticipation.
g. Explain to the client to maintain the entrance with plenty of fluids to drink.
Dx 4: disturbance of personal hygiene needs in connection with their activity limited.
a. Give an explanation of the importance of personal hygiene
b. Give me motivation to continue to maintain personal hygiene without doing excessive activity
c. Give a means of supporting or bathe the client when the client still need bedrest
Dx 5: Disorders of psychological anxiety in connection with the lack of knowledge about a troubled pregnancy ..
a. Give support and education to reduce anxiety and increase understanding and cooperation while providing information about the status of the fetus, listen attentively, maintain eye contact and communicate with the calm, warm and appropriate empathy.
b. Maintain a relationship of trust with open communication. Relationship of mutual trust established between the nurse and the client will make the client easier to express feelings and willing to cooperate.
c. Tell us about the process of treatment and prognosis of disease gradually. By understanding the process of treatment and prognosis of disease will provide a sense of calm.
d. Identification of the construction and reinforced coping. With the identification and alternative coping will assist clients in resolving the problem.
e. Do visit regularly to provide support systems. With the support system will make the client feel optimistic about his recovery.
Reading List:
RI health manpower. (1993) Midwifery Care In Context On Family Breast Care, MOH
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