# Placenta previa and placenta abruptio



## RedheadErin (Aug 24, 2013)

At what point during the delivery do you know either of these conditions exists?


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## NomadicMedic (Aug 24, 2013)

Well. If that doesn't sound like a homework question, I don't know what does.


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## Anjel (Aug 24, 2013)

We won't give you answers. We will help you work through it though.

What is placenta previa?

What is placenta abruptio?


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## mycrofft (Aug 24, 2013)

RedheadErin said:


> At what point during the delivery do you know either of these conditions exists?



After the doctor at the hospital does an ultrasound.


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## Mariemt (Aug 24, 2013)

Bleeding is a very good indicator.  
Someone with prenatal care will know about one... can you guess?


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## Akulahawk (Aug 24, 2013)

Mariemt said:


> Bleeding is a very good indicator.
> Someone with prenatal care* will know about one*... can you guess?


Someone with prenatal care will know if they have one of those two conditions... 

One can be detected early on with good prenatal care... the other is usually a surprise finding.


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## RedheadErin (Aug 24, 2013)

Well yes I know what they are.  Previo is when the placenta develops over the cervix.  Abruptio is when the placenta tears "abruptly" away from the wall of the uterus.  I already found out that abruptio produces sudden severe pain and copious bleeding.   So that one would be obvious.  

As for previo, not all women have decent pre-natal care and ultrasounds.  Sometimes they don't even know they are pregnant.  Maybe she is  just being obtuse and won't tell ME she has it, for whatever reason.  At any rate, if I show up at the door and this woman is in labor, how am I going to know if  she has placenta previa, assuming she doesn't tell me?


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## DesertMedic66 (Aug 24, 2013)

RedheadErin said:


> Well yes I know what they are.  Previo is when the placenta develops over the cervix.  Abruptio is when the placenta tears "abruptly" away from the wall of the uterus.  I already found out that abruptio produces sudden severe pain and copious bleeding.   So that one would be obvious.
> 
> As for previo, not all women have decent pre-natal care and ultrasounds.  Sometimes they don't even know they are pregnant.  Maybe she is  just being obtuse and won't tell ME she has it, for whatever reason.  At any rate, if I show up at the door and this woman is in labor, how am I going to know if  she has placenta previa, assuming she doesn't tell me?



Since the placenta develops in a different area which one are you likely to see as she is pushing, the baby or the placenta?


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## RedheadErin (Aug 24, 2013)

I had hoped to find out before she is fully dilated and pushing.  Isn't she going to  have some bleeding before then?


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## VFlutter (Aug 24, 2013)

RedheadErin said:


> I already found out that abruptio produces sudden severe pain and copious bleeding.   So that one would be obvious.



Many cases are not as "obvious" as you would think. The copious bleeding may be occult so do not let the lack of visible vaginal bleeding dissuade you. You do not want to be behind the 8 ball with a pregnant patient who is in shock and coagulopathic with a fetus in acute distress.


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## Anjel (Aug 24, 2013)

RedheadErin said:


> I had hoped to find out before she is fully dilated and pushing.  Isn't she going to  have some bleeding before then?



Not always. Maybe just a little spotting and if she is in labor than you might attribute that to the actual birthing process. But if she starts to deliver and you see the placenta and not baby, that's when you would know.


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## mycrofft (Aug 24, 2013)

Pregnancy leading to severe onset bleeding and pain= go to hospital code 3, try to stabilize internal bleeding effects enroute.

Pregnancy resulting in prolonged ineffective labor and vaginal bleeding = go to hospital, support vital signs enroute.

Try THIS one!

http://en.wikipedia.org/wiki/Placenta_accreta


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## RedheadErin (Aug 24, 2013)

Thanks for the help. My finals are coming next week and I am trying to fill in some holes in my knowledge.  

In related news, how much oxygen would you give a non-complicated pregnant woman on the way to the hospital?


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## Anjel (Aug 24, 2013)

RedheadErin said:


> Thanks for the help. My finals are coming next week and I am trying to fill in some holes in my knowledge.
> 
> In related news, how much oxygen would you give a non-complicated pregnant woman on the way to the hospital?



None? If there is nothing wrong and no signs of difficulty in breathing, poor perfusion, or hypoxia... They get nothing


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## RedheadErin (Aug 24, 2013)

My stupid book says to give oxygen, but I cant find anywhere it says how much to give.  :blink:


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## VFlutter (Aug 24, 2013)

RedheadErin said:


> My stupid book says to give oxygen, but I cant find anywhere it says how much to give.  :blink:



When in doubt, NRB @ 15 LPM


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## Anjel (Aug 24, 2013)

RedheadErin said:


> My stupid book says to give oxygen, but I cant find anywhere it says how much to give.  :blink:


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## RedheadErin (Aug 24, 2013)

Ha! Thanks for the advice and the laugh!


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## Aidey (Aug 24, 2013)

Anjel said:


> None? If there is nothing wrong and no signs of difficulty in breathing, poor perfusion, or hypoxia... They get nothing



Well, I would suggest at least 21ish%, lol. :lol:


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## RedheadErin (Aug 25, 2013)

> Pregnancy leading to severe onset bleeding and pain= go to hospital code 3, try to stabilize internal bleeding effects enroute.
> 
> Pregnancy resulting in prolonged ineffective labor and vaginal bleeding = go to hospital, support vital signs enroute.



So the placenta previa would result in prolonged ineffective labor?


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## JPINFV (Aug 25, 2013)

RedheadErin said:


> At what point during the delivery do you know either of these conditions exists?


1. Previa: After the ultrasound prior to entering labor. 

2. Fetal distress on the monitor. 


Oh, prehospital? Yea... those answers aren't helpful.


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## RedheadErin (Aug 25, 2013)

My problem is, I am preparing for my wildcard exam on tuesday.  I have a list of some 60 topics, ONE of which I will have to give a 10-minute presentation on.  "OB Delivery with Placenta Previa" and "OB Delivery with Placenta Abruptio" are 2 of the 60 topics. 

My book covers a normal delivery in excruciating, redundant detail, but gives about 50 words each to P. Previa and P. Abruptio.  I have no idea at all how I would handle a delivery with either of these conditions. 

All I can think to do is treat for shock, rapid transport, and keep track of how many pads they soaked. What else could I do?


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## JPINFV (Aug 25, 2013)

RedheadErin said:


> My book covers a normal delivery in excruciating, redundant detail, but gives about 50 words each to P. Previa and P. Abruptio.  I have no idea at all how I would handle a delivery with either of these conditions.


1. Scheduled c-section.

2. Vaginal delivery with coag panels, fetal monitoring, and an OB/Gyn ready to perform a crash c-section if the baby shows distress.


Prehospital? PUHA.


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## STXmedic (Aug 25, 2013)

The information in your book probably isn't all that excruciating...

What are these wildcards you speak of? Are you presented with a topic and expected to give a presentation on the spot?


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## RedheadErin (Aug 25, 2013)

It is excruciating, especially when you have to read through all the redundancies to find one little thing you are looking for.....

The wildcard is the first part of my final exam (along with a written exam and a practical.)  We have this long list of possible topics and we are expected to be prepared for all of them.  Then on test day, we will each draw a topic out of a hat or something and have to give a 10 minute presentation on the spot, using only materials found in the classroom.  No notes.  I don't think we will even have more than a minute or two of prep time, if that much. 

SOmetimes I think my instructor is psychotic, or at least a little strange.....:blink:


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## STXmedic (Aug 25, 2013)

Assuming your instructor gave you adequate instruction throughout the course, I like him.  He expects you to know your stuff instead of pushing everyone through.


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## RedheadErin (Aug 25, 2013)

I like him, too, for the same reasons.  But his lecture style is a little scattered, and he departs drastically from the book.   This won't be the first time he has expected us to know something nobody remembers hearing. 

But back to my original problem: 

I show up at somebody's door, she is pregnant and something is wrong. Will either or both of these conditions cause vaginal bleeding? Will they force a premature labor? Assuming she has not had great prenatal care, is it possible to know if she has a placenta previa or a placenta abruptio? Most importantly, what do I do for her?


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## Anjel (Aug 25, 2013)

Treat for shock, rapid transport, keep her warm, and monitor for signs of imminent delivery. 

Placenta abruptio- can be very painful and heavy bleeding.

Previa- usually painless light bleeding. 

That's all you can do.


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## RedheadErin (Aug 25, 2013)

Thanks!  I have wasted the better part of an evening trying to figure that out.

These are both conditions of the 3rd trimester, right? Would I see this if the baby was full term and ready to deliver, or does it usually accompany or cause a premature birth? 

And I wouldn't be trying to deliver a baby in this case, I would be trying to get her to the hospital as fast as I could.  

Just say, the contractions are coming fast and hard and delivery is imminent  or the baby is crowning.  There a bunch of blood and a history consistent with p. abruptio,  or else her doc told her she has placenta previa? Then what?


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## Anjel (Aug 25, 2013)

Drive faster. Elevate the pelvis with padding. If the baby is crowning and you see the head. Then prepare for delivery and just do the best you can. There's gonna be a lot of blood with abruptio. My patient that I had. It looked like a murder scene in the apartment and in the back of the truck. She had two large bore IVs lots of fluids and lots of diesel. There is nothing we can do prehospital to help save this patient or the baby. 

Just supportive care and transport.


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## RedheadErin (Aug 25, 2013)

Ok, thanks.  

How did your patient turn out?


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## Anjel (Aug 25, 2013)

RedheadErin said:


> Ok, thanks.
> 
> How did your patient turn out?



She was ok. She was 38weeks and  Baby didn't make it.


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