The placenta is a temporary organ that connects your baby to your uterus during pregnancy.

The
placenta develops shortly after conception and attaches to the wall of your uterus. Your baby is
connected to the placenta by the umbilical cord. Together, the placenta and umbilical cord act as
your baby's lifeline while in the uterus
Functions of the placenta include:

Provides your baby with oxygen and nutrients.

Removes harmful waste and carbon dioxide from your baby.
Produces hormones that help your baby grow.
Passes immunity from you to your baby.
Helps protect your baby.

The placenta takes over hormone production by the end of the first trimester (12 weeks of
pregnancy). Up until this time, the corpus luteum handles most of the hormone production. Many
people's first-trimester symptoms of nausea and fatigue go away once the placenta takes over in
the second trimester.

PLACENTA PREVIA

the placenta has implanted at the bottom of the uterus, over the cervix or close by, which means
lp;kjur6hj the baby can't be born vaginally.

The placenta is an organ that develops in the uterus during pregnancy. In most pregnancies, the
placenta attaches at the top or on the side of the uterus. In placenta previa, the placenta attaches
low in the uterus. The placenta might partially or completely cover the opening of the uterus,
called the cervix. Placenta previa can cause severe bleeding in the mother before, during or after
delivery.

The main sign of placenta previa is bright red vaginal bleeding, usually without pain, after 20
weeks of pregnancy. Sometimes, spotting happens before an event with more blood loss.

The bleeding may occur with prelabor contractions of the uterus that cause pain. The bleeding
may also be triggered by sex or during a medical exam. For some women, bleeding may not
occur until labor. Often there is no clear event that leads to bleeding.

EVALUATE HEMATOCRIT AND HEMOGLOBIN - assessed to establish baselines, detect a

possible clotting disorder, and ready blood for replacement if necessary

 Place the client Immediately on bed rest in a side-lying position

 Properly do an assessment
 Inspect the perineum for bleeding and estimate the present rate of blood loss
 Weighing of perineal pads before and after use - to determine vaginal blood loss
 Apt or Kleihauer–Betke test (test strip procedures) can be used to detect whether
the blood is of fetal or maternal origin
 Obtain baseline vital signs - to determine whether symptoms of hypovolemic shock
are present
 Continue to assess blood pressure every 5 to 15 minutes
 Never attempt a pelvic or rectal examination with painless bleeding - because any
agitation of the cervix when there is a placenta previa might tear the placenta further and
initiate massive hemorrhage, possibly fatal to both mother and child.
 Bv bAttach external monitoring equipment
 Monitor urine output - as often as every hour, as an indicator her blood volume is remaining
adequate to perfuse her kidneys
ABRUPTIO PLACENTA

Abruptio placentae is defined as the premature separation of the placenta from the uterus.
Patients with abruptio placentae, also called placental abruption, typically present with
bleeding, uterine contractions, and fetal distress. A significant cause of third-trimester
bleeding associated with fetal and maternal morbidity and mortality, placental abruption
must be considered whenever bleeding is encountered in the second half of pregnancy.

The separation generally occurs late in pregnancy; even as late as during the first or second stage of
labor. Because premature separation of the placenta may occur during an otherwise normal labor, it is
important to always be alert to both the amount and kind of pain and vaginal bleeding a woman is
having in labor.

Heavy bleeding usually accompanies premature separation of the placenta, although it may not be
readily apparent. External bleeding will only be evident if the placenta separates first at the edges, so
blood escapes freely into the uterus and then the cervix. In contrast, if the center of the placenta
separates first, blood can pool under the placenta, and although bleeding is just as intense, it will be
hidden from view. Whether blood is evident or not, signs of hypovolemic shock usually follow quickly.

Chorioamnionitis or intraamniotic infection is an acute inflammation of the membranes and chorion of

the placenta, typically due to ascending polymicrobial bacterial infection in the setting of membrane
rupture. caused by bacteria commonly found in the vagina. It happens more often when the bag of
waters (amniotic sac) is broken for a long time before birth. This lets bacteria in the vagina move up into
the uterus.

Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood
clotting throughout the body's blood vessels. You may develop DIC if you have an infection or injury that
affects the body's normal blood clotting process.

Couvelaire uterus or uteroplacental apoplexy, forming a hard, boardlike uterus occurs. As bleeding
progresses, a woman’s reserve of blood fibrinogen becomes diminished as her body attempts to
accomplish effective clot formation. Uteroplacental apoplexy is a rare but nonfatal complication of
severe forms of placental abruption. It occurs when vascular damage within the placenta causes
hemorrhaging that progresses to and infiltrates the wall of the uterus.

 Fluid replacement - large-gauge intravenous catheter inserted for fluid replacement and
 Oxygen by mask - to limit fetal anoxia. ( inadequate oxygenation of the mother, low maternal
blood pressure, or abnormalities in the uterus, placenta, or umbilical cord that result in
inadequate blood flow to the fetus.)
 Monitor FHB
 Monitor maternal vital signs every 5 -15 mins - to establish baselines and observe
progress
 Keep on lateral position - to prevent pressure on the vena cava and additional
interference with fetal circulation
 Do not perform any vaginal or pelvic exam - not to disturb the injured placenta any further.
 If vaginal birth does not seem imminent, cesarean birth is the birth method of choice
 Intravenous administration of fibrinogen or cryoprecipitate

Cryoprecipitate is the part of plasma that contains a number of clotting proteins (factors) that
help control bleeding. It's made by thawing fresh frozen plasma (FFP) between 1 and 6˚C and
then collecting the cold-insoluble proteins (precipitate).
Fibrinogen the formation of fibrin that binds together platelets and some plasma proteins in a
hemostatic plug. In pathological situations, the network entraps large numbers of erythrocytes
and leukocytes forming a thrombus that may occlude a blood vessel.

INVERTED UTERUS

It is a rare phenomenon, occurring in about 1 in 20,000 births (Furukawa & Sameshima, 2015). It may
occur if traction is applied to the umbilical cord to remove the placenta or if pressure is applied to the
uterine fundus when the uterus is not contracted. It may also occur if the placenta is attached at the
fundus so that, during birth, the passage of the fetus pulls the fundus downward.

Because inversion occurs in various degrees, the inverted fundus may lie within the uterine cavity or the
vagina, or in total inversion, it may protrude from the vagina. When an inversion occurs, a large amount
of blood suddenly gushes from the vagina. The fundus is no longer palpable in the abdomen.

 Never apply pressure on an uncontracted uterus - because handling of the uterus could
increase the bleeding
 Never pull the cord to hasten placental delivery - because this would create a larger surface
area for bleeding
 Nitroglycerin or a tocolytic drug by IV - to relax the uterus.
 Administration of oxytocin after manual replacement - helps the uterus to contract and
remain in its natural place
 Antibiotic therapy - Because the uterine endometrium was exposed
 Cesarean Birth, necessary for future pregnancy - to prevent the possibility of repeat inversion.
 IF Oxytocin, if being used, should be discontinued because it makes the uterus more tense and
difficult to replace

MUSCLE RELAXANTS DRUGS:

- Diazepam
- Metaxalone
- Chlorzoxazone

Abnormal Fetal Position