Placenta and Placental Anomalies

Placenta

• Spongy structure within the uterus that nourishes the fetus.
• Organ created during pregnancy.
• Removes waste from the fetus.
• Produces hormones to sustain pregnancy.
• Attached to the wall of the uterus by blood vessels.
• Supplies the fetus with oxygen and nutrition.
• Removes waste from the fetus and then transfers it to the mother.
• The fetus receives nourishment and oxygen and expels waste through the umbilical cord.
• One side of the placenta allows maternal blood to circulate, while the other side allows fetal blood to circulate.

Placental Anomalies

• Abnormalities in the size of the placenta or the blood vessels connected to it
• Normal placenta characteristics:
  • Weighs about 500 grams.
  • Measures 15-20 cm in diameter and 2-3 cm thick.
  • Flat, cakelike round or oval shape.
  • The maternal side is lobulated.
  • The fetal side is shiny.

Several Types of Placental Anomalies

• Battledore placenta: the cord is inserted marginally rather than centrally.
• Placenta succenturiata: one or more accessory lobes are connected to the main placenta by blood vessels.
• Placenta Circumvallata: a thickened greyish-white ring on the fetal surface, created by a double fold of the amnion and chorion.
• Placenta accreta: chorionic villi are deeply attached onto or into the myometrium.
• Velamentous insertion of the cord: the cord separates into small vessels that reach the placenta by spreading across a flood of amnion.

Causes of Placental Anomalies

• Unknown, but possible contributors include:
  • Women with diabetes mellitus (DM).
  • Certain diseases like syphilis or erythroblastosis.
  • Placenta wider in diameter

Treatment for Placental Anomalies

• Complete visual inspection of the placenta after birth.
• Manual removal of the placenta when succenturiata is present.
• Methotrexate may be given for acreta cases to destroy the remaining attached tissue to the uterus.
• Hysterectomy may be necessary for acreta cases

Nursing Interventions for Placental Anomalies

• Inspect the placenta after delivery to make sure that it is in good condition.
• Assist with manual removal of placenta succenturiata.
• Prepare the patient for a possible C-section birth.
• Offer emotional support and explain all treatments to the patient and family.
• Monitor the patient closely in the immediate postpartum period.

Amniotic Fluid Embolism (AFE)

• Amniotic fluid escapes into maternal circulation
• Rare but serious condition that occurs when the amniotic fluid, or fetal material enters the mother's bloodstream.
• Results from a defect in the membranes rupture or from partial abruptio placenta
• The fetus risks possible deposition of meconium and vernix in the pulmonary arterioles

Causes of AFE

• Unknown, but predisposing factors include:
  • Intrauterine fetal death
  • Abruptio placenta
  • Advanced maternal age

Assessment Findings for AFE

• Sudden dyspnea
• Loss of consciousness
• Hemorrhage
• Cyanosis
• Increasing restlessness and anxiety
• Respiratory failure
• Cardiac arrest

Treatment for Amniotic Fluid Embolism

• Administration of oxygen, blood, and heparin
• Close monitoring of cardiopulmonary status
• Immediate delivery of the infant
• Insertion of central venous pressure line
• Manage symptoms to prevent AFE from leading to coma and death.

Nursing Interventions for Amniotic Fluid Embolism

• Administer O2 via face mask and monitor VS every 15 minutes for changes.
• Anticipate the need for endotracheal intubation to maintain pulmonary function.
• Prepare to initiate CPR.
• Arrange to transfer the patient to the intensive care unit and prepare for immediate delivery of the fetus by C-section.
• Provide emotional support to the family.

Client's Psychological State

• Maternal response and psychological readiness for labor.
  • Involves feelings of anticipation, excitement, or apprehension

Psyche

• Refers to the feelings that the woman brings to labor.
• A major component is the psychological readiness for labor.
• Factors affecting psychological readiness:
  • Presence of support systems positively affects the woman's ability to manage labor
  • Preparations for childbirth

Maternal Psychological Responses during Labor - 1st Stage

• Mother feels anticipation, excitement, or apprehension.
• During the active phase, the mother becomes serious and may ask for pain medication or use breathing techniques and/or relaxation techniques.
• During the transitional phase, she may lose control, thrash in bed, groan, or cry.

Maternal Psychological Responses during Labor - 2nd Stage

• Maternal behavior changes from coping with contractions to actively pushing
• The patient may become exhausted

Maternal Psychological Responses during Labor - 3rd Stage

• Mother focuses on the neonate's condition
• Patient may feel discomfort from uterine contractions before expelling the placenta

Maternal Psychological Responses during Labor - 4th Stage

• Mother's attention is focused on neonate and she begins to adjust to the role of mother
• The primary activity is promoting maternal-neonatal bonding

Problems with the Psyche Factor

• Inability to bear down properly.
• Health teachings:
  • Proper breathing techniques
  • Proper position during labor process
  • Be attentive to physician coaching/instruction

Fear/Anxiety

• Thorough explanation of the treatment/procedure being done to pt, as well as pts and fetal condition
• Encourage verbalization of feelings
• Be available to patient needs
• Provide with diversionary activities to refocus attention