Placenta Previa, Abruptio Placentae, DIC (Test 4)
Lab Studies for DIC: - platelet: - fibrinogen: - fibrinogen degradation: -dDimer serum
- platelet decreased - fibrinogen decreased - fibrinogen degradation INCREASED - dDimer will be positive for DIC
What is critical to remember about vaginal bleeding in pregnancy?
1. NO manual exams and 2. no pitocin until the location of the placenta has been verified by u/s and a previa has been ruled out.
What is the criteria for the mother to be sent home with placenta previa? (5)
1. lives close to the hospital 2. not actively bleeding 3. help 24 hours around the clock 4. understands the risks and management 5. bed rest is available at home
What are the 4 classifications of abruptio placentae?
1. marginal 2. complete 3. concealed 4. partial
What are the three main groups outlined in the book that cause DIC?
1. thromboplastin infusion (abruptio placentae, prolonged retention of dead fetus) 2. endothelial damage (pre-eclampsia, HELLP) 3. non specific effects (maternal sepsis, amniotic fluid embolism)
Oxygen may be administered as high as ______ L/min
10-12
What is a critical assessment finding that you would report right away regarding urinary output?
30mL/ hour or less
What labs are done if the patient is actively bleeding?
CBC, type-screen, crossmatch
What is important to remember about ultrasounds when it comes to the patient?
FULL bladder to raise the uterus!
Does the bleeding have to be evident to show signs of hypovolemic shock? why?
NO! bleeding can occur behind the placenta and the margins will remain in tact creating a hematoma.. the blood is still being lost
Does bleeding loss always correspond with the actual amount of blood loss shown.
No! a hematoma could be formed
What are other signs of abruptio placentae?
abdominal tenderness, high resting tone, frequent low intensity contractions, uterine irritability, bleeding (can be evident or concealed), back pain, nonreassuring patterns, fundus may rise
What is placenta previa?
abnormal placenta implantation in the lower uterine segment
_______ is the separation of the normally implanted placenta before the fetus is born.
abruptio placentae
What are risk factors for DIC?
abruptio placentae, retention of dead fetus in utero, pre-eclampsia, hemolysis, increased levels of liver enzymes, low platelet levels, maternal sepsis, amniotic fluid embolism
What management is usually taken place for abruptio placentae? active or conservative/expectant?
active because actively bleeding
What does active management mean with placenta previa?
actively starting interventions because there is hemorrhaging, mother/fetus compromise, or hypovolemic shock is present
Major dangers for the fetus with abruptio placentae: (3)
asphyxia, fetal blood loss, prematurity
The nurse might be unsure if the patient is bleeding from placenta previa because it may be the passage of the __________.
bloody show
When does the painless vaginal bleeding occur and why does it occur?
can occur in the last half of pregnancy or at birth; it occurs because the placenta villi are pulling from the uterine wall as the lower uterine segment begins to thin and the cervical os begins to dilate
A main risk factor for abruptio placentae is vasoconstriction.. what are examples?
cocaine use, hypertension, smoking
If the mother is reasonably stable, what is the management that will be done?
conservative, leave the baby in the uterus to continue to grow
What can be given to the mother to increase fetal lung maturity?
cortiocosteroids
What are early signs of hypovolemic shock?
fetal and maternal tachycardia, normal or slightly decreased maternal blood pressure, increased respirations and decreased oxygen sat, cool, pale skin and mucous membranes
What are the 2 major concerns with abruptio placentae?
fetal hypoxia excessive bleeding
What is the patient with placenta previa at risk for?
hemorrhage because of the bleeding
Major dangers for the woman with abruptio placentae are: (3)
hemorrhage, hypovolemic shock, clotting abnormalities
How is placenta previa diagnosed?
high resolution ultrasound
The Serial Kleihauer-Betke (K-B) test determines what?
if fetal bleeding is worsening
When would a c-section be initiated in an actively bleeding mother?
if the fetus is over 36 weeks and the lungs are mature
What size IV's should the nurse use to administer blood products to the actively bleeding patient?
large bore IV's - 16-18 gauge
Is restlessness, agigtation, decreased mental abilities an early or late sign of hypovolemic shock?
late sign - decreasing in oxygen getting to the brain
What classification is common during early pregnancy? Does it remain that way?
marginal is common, but it subsides when the fetus grows and moves upward and away
What are the three classifications of placenta previa?
marginal, partial, total
What are risk factors for placenta previa?
multi paras, previous c-sections, previous previa, fetus a boy, african/asian women, smoking/cocaine use, uterine scarring, elective abortions
Is u/s reliable for abruptio placentae?
no, may not
What is the cardinal sign of abruptio placentae?
painful bleeding
What is the cardinal sign of placenta previa?
painless vaginal bleeding
Amniotic fluid will have a _______ color with abruptio placentae.
port wine
If there is a positive D-dimer test, what does that indicate?
positive for fibrin split products, and positive for increased fibrin degradation products
What is Disseminated Intravascular Coagulopathy?
rapid consumption of coagulation factors that results in the body being unable to form clots; can result in fatal hemorrhage
Why is oliguria a late sign of hypovolemic shock?
the kidneys are starting to fail, and the output becomes decreased. the body's compensatory mechanism is to send the blood to the brain and heart before the kidneys
How much of the cervical os does partial previa cover?
the lower border is within 3 cm of the internal cervical os but does not completely cover
What is marginal placenta previa?
when the placenta is on the side; >3 cm away from cervical os
