Placenta Complications in Pregnancy PDF

PLACENTA Complications in Pregnancy The PLACENTA is a vital organ that develops during pregnancy and serves as a life support system for the fetus. Functions of the placenta: Nutrient and oxygen transfer from mother to fetus. Waste removal from fetus to mother. Hormone prod...

PLACENTA Complications in Pregnancy The PLACENTA is a vital organ that develops during pregnancy and serves as a life support system for the fetus. Functions of the placenta: Nutrient and oxygen transfer from mother to fetus. Waste removal from fetus to mother. Hormone production (e.g., HCG, progesterone). Immunological protection (barrier against infections).  Placental complications can pose significant risks to both the mother and fetus. Common placental complications include: 1.Placental Abruption 2.Placenta Previa 3.Placenta Accreta, Increta, and Percreta 4.Vasa Previa 5.Placental Insufficiency 6.Retained placenta Placental complications can pose significant risks to both the mother and fetus. PLACENTAL ABRUPTION The premature separation of the placenta from the uterine wall before delivery. It occurs most commonly around 25 weeks of pregnancy. Types of placental abruption: Partial The placenta only separates in a small area. In mild cases, a doctor may monitor the patient closely and limit activity. Complete The placenta completely separates from the uterine wall, which usually results in significant bleeding. In this case, the baby will need to be delivered immediately. Revealed There is moderate to severe vaginal bleeding that is visible. Concealed There is little or no visible vaginal bleeding because the blood is trapped between the placenta and uterine wall.  Placental abruption can be classified by the severity of the abruption TYPE PERCENTA GE OF FETAL MATERNAL SYMPTOMS MANAGEMENT PLACENTA DISTRESS CONDITION DETACHED Mild abdominal Rare Maternal vital Observation, pain, minimal signs stable possibly bed rest, Grade 1 (Mild) < 25% bleeding, tender monitor fetal well- uterus being Moderate pain, Present Possible shock, Continuous fetal moderate vaginal tachycardia monitoring, Grade 2 25-50% bleeding, uterine possibly early (Moderate) contractions delivery, blood transfusion Severe pain, Severe or Hypovolemic Emergency profuse bleeding, absent shock, rapid cesarean, stabilize rigid uterus, deterioration maternal Grade 3 > 50% maternal shock condition, blood (Severe) transfusion, postpartum Smoking Early membrane rupture during the pregnancy A placental abruption unrelated to abdominal trauma in a previous pregnancy or a family history of placental abruption​ An infection in the uterus during the pregnancy Cocaine use during pregnancy​ Mother has asthma Maternal age of 35 or older Carrying multiple babies Hypertension and related problems in the pregnancy, such as preeclampsia and eclampsia​ Maternal exposure to air pollution A fall or blow to the abdomen during the pregnancy Water breaks before 37 weeks Symptoms: Sudden lower abdominal pain Problems with the baby’s heart rate Vaginal bleeding. Tense, rigid uterus. Fetal distress (e.g., decreased fetal movement) Dangerously low blood pressure  Diagnosis and Tests A healthcare provider will use a combination of tests and a physical exam to diagnose placental abruption, including: Physical exam: Checks for uterine tenderness or rigidity Ultrasound: Uses high-frequency sound waves to create an image of the uterus and locate bleeding. However, it's not always possible to see a placental abruption on an ultrasound. Blood and urine tests: May include a complete blood count (CBC), blood and Rh typing, prothrombin time/partial thromboplastin time (PT/PTT), and serum fibrinogen and fibrin-split products Fetal monitoring: Monitors the fetal heart rate and movement  General Management Approach: 1. Initial Assessment: Assess vital signs: BP, heart rate, respiratory rate. Evaluate fetal heart rate: Continuous monitoring for signs of distress. Perform a physical examination to check for uterine tenderness, rigidity, or abnormal contractions. If bleeding is visible, estimate the amount of blood loss. 2. Stabilization: IV access for fluids and possible blood transfusion. Oxygen therapy to support maternal and fetal oxygenation. Blood work to assess hemoglobin, hematocrit, coagulation profile, and organ function.  General Management Approach: 3. Delivery Consideration: If fetal distress is present or if the pregnancy is term, cesarean section is the preferred delivery method. If mother and fetus stable, observe for a longer period in the hospital if the pregnancy is near term. 4. Postpartum Care: Monitor for hemorrhage, uterine tone, and signs of shock. Close maternal monitoring in the immediate postpartum period due to risk of postpartum PLACENTA PREVIA PLACENTA PREVIA when the placenta attaches inside the uterus but in a position near or over the cervical opening. Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Types of Placenta Previa: As the pregnancy progresses and the uterus grows, the placenta moves through the uterus. During the first months of pregnancy, it is common for the placenta to be in the lower part of the uterus, but as the weeks progress, it grows and is located in the upper part. Once the third trimester of pregnancy arrives, the placenta measures about 22 cm and weighs about 0.5 kg, and must already be at the top of the uterus to clear the birth canal. If this does not happen, there will be a placenta previa problem, in which the following types can be differentiated: Low lying placenta: the placenta is in the lower segment of the uterus but does not reach the opening of the cervix. Marginal previa: the placenta is next to the cervix but does not cover the opening. Partial previa: the placenta covers part of the cervical opening. Complete previa: the placenta covers the entire cervical opening. This type is also known as type IV placenta previa. Causes/Risk Factors: Twin pregnancy or Multiple pregnancy Having had several previous pregnancies Short time between two births Having had a previous CS Uterine scars from previous abortions or surgeries Advanced maternal age Tobacco and cocaine abuse Placenta previa occurs in 1 in 200 pregnant women in the third trimester of gestation.  Diagnosis The placenta previa is diagnosed by ultrasound, which shows whether the position of the placenta is correct or not. If this condition is detected before the third trimester of pregnancy, there is no cause for alarm, as the placenta is likely to vary in position as the uterus enlarges. Only 30% of women with placenta previa before the 24th week of pregnancy still keep it in that position at the time of delivery.  Symptoms and Treatment The main symptoms are painless vaginal bleeding with bright red blood and variable intensity. Bleeding occurs because the cervix begins to dilate and ruptures the blood vessels in the placenta and the area where it is implanted. This bleeding may stop on its own and start again a few days later. Sometimes vaginal bleeding does not occur until labor begins.  Childbirth with placenta previa The way to proceed when giving birth with placenta previa will depend on the type and severity. In case of pregnancy with uncomplicated placenta previa, a vaginal delivery or cesarean section is scheduled around 37 weeks. Carrying a pregnancy to term is not recommended as the risk associated with placenta previa could be much worse than having a preterm birth. For example, an emergency cesarean section should be performed if severe bleeding occurs in the last weeks of gestation.  If the woman is less than 35 weeks pregnant, she will remain hospitalized to control bleeding and, in case of fetal distress and/or unstoppable bleeding, a c-section will also be performed.  Critical Thinking: What care should be taken during pregnancy with placenta previa? Answer: If your doctor diagnoses placenta previa during a follow-up ultrasound, he or she will most likely recommend that you do not exert yourself physically, lead a quiet life, and abstain from sexual intercourse. Long trips, especially abroad, should also be avoided, as well as stress or exhaustion. In case of vaginal bleeding, the woman should go to the emergency room as soon as possible. PLACENTA ACCRETA INCRETA PERCRETA  Three variants of abnormally invasive placentation are recognised: placenta accreta, in which placental villi invade the surface of the myometrium placenta increta, in which placental villi extend into the myometrium placenta percreta, where the villi penetrate through the myometrium to the uterine serosa and may invade adjacent organs, such as the bladder.  THE SEVERITY OF INVASION INCREASES FROM: ACCRETA (shallow attachment) INCRETA (deeper attachment into the uterine muscle) PERCRETA (penetration through the uterine wall and possibly into surrounding structures). THESE CONDITIONS ARE ASSOCIATED WITH SIGNIFICANT MATERNAL MORBIDITY AND MORTALITY, PARTICULARLY DUE TO EXCESSIVE BLEEDING DURING DELIVER Y.  PLACENTA ACCRETA The placenta attaches firmly to the uterine wall without passing through it. This is the most common type. PLACENTA INCRETA The placenta is more deeply embedded in the uterine wall, attaching firmly to the uterine muscle. This type accounts for about 15% of cases. PLACENTA PERCRETA The placenta passes through the uterine wall and may extend into nearby organs, such as the bladder or intestines. This is the most severe type and accounts for about 5% of cases.  THIS OFTEN LEADS TO TWO MAJOR COMPLICATIONS: Life-threatening maternal hemorrhage Large-volume blood transfusion Peripartum hysterectomy Pre-eclampsia Preterm labor Disseminated intravascular coagulation (DIC) Shock  WHO IS AT RISK ? Previous uterine surgery. The risk of placenta accreta increases with the number of C-sections or other uterine surgeries you've had. Placenta position. If the placenta partially or totally covers your cervix (placenta previa) or sits in the lower portion of your uterus, you're at increased risk of placenta accreta. Maternal age. Placenta accreta is more common in women older than 35. Previous childbirth. The risk of placenta accreta increases as your number of pregnancies increases. Smoking and Chronic Hypertension.  SYMPTOMS AND COMPLICATIONS COMPLICATIONS AND RISKS FOR THE BABY When placenta accreta occurs with placenta previa, or when there is suspicion for percreta, the delivery is often scheduled prematurely. This will usually occur between 34 and 37 weeks gestation (3-6 weeks early), depending on the severity of the accreta. Babies born at these gestational ages often require admission to a newborn intensive care unit, but their overall prognosis is good. If there is early, heavy bleeding, then the delivery may need to occur even earlier. If heavy bleeding from a previa makes the mother unstable, then the baby can become unstable as well. The accreta itself is not directly harmful to the baby.  SYMPTOMS AND COMPLICATIONS COMPLICATIONS AND RISKS FOR THE MOTHER Hemorrhaging (severe bleeding) may occur from an associated placenta previa, or from attempts to remove the placenta when it is stuck to the uterus. If not managed and treated carefully, this may be life threatening. A vaginal birth is not always possible. Women who do deliver vaginally may require specialized procedures to remove the placenta and control hemorrhaging. If a placenta accreta is diagnosed before labor, the provider may recommend a Cesarean section. A hysterectomy (the surgical removal of the uterus) may be required after delivery to remove the placenta and end blood loss. Placenta penetrates through myometrium and uterine serosa on the left lateral side of the uterus (arrow).  DIAGNOSIS: Placenta accreta, increta, and percreta are most commonly diagnosed prenatally using imaging methods, typically in the second and third trimesters (starting around 20 weeks of pregnancy). Early detection is critical for planning delivery and managing potential complications.  Diagnosis: 1. Ultrasound: STANDARD ULTRASOUND: Can detect abnormal placental attachment, but the findings may not always be definitive. COLOR DOPPLER ULTRASOUND: This is particularly useful in evaluating blood flow and identifying abnormal vascularity at the placental bed. It can show abnormal blood vessels and placental invasion into the uterine wall.  Diagnosis: 2. Magnetic Resonance Imaging (MRI): MRI is a helpful adjunct, especially when the ultrasound findings are inconclusive. It provides a clearer image of the placental invasion and can help delineate the extent of the invasion. MRI can distinguish between accreta, increta, and percreta and assess involvement of surrounding organs like the bladder.  Diagnosis: 3. Clinical Suspicion: Risk factors (see below) should raise suspicion for placenta accreta and prompt closer monitoring. Clinical signs of possible placenta accreta can include abnormal bleeding (especially during the third trimester), a lack of placental separation after delivery, or a non-relaxing uterus.  MANAGEMENT AND TREATMENT: 3. Clinical Suspicion: Management depends on the severity of the condition (accreta, increta, or percreta) and gestational age. The goal is to reduce maternal morbidity and mortality, which is mainly related to bleeding. MANAGEMENT AND TREATMENT: Multidisciplinary Team Antenatal Care Delivery Planning Postpartum Care  MEDICATIONS While medications cannot directly treat placenta accreta, increta, or percreta, several medications are used to manage the condition and associated complications: 1. PROPHYLACTIC ANTIBIOTICS: Given to prevent infection, particularly if a hysterectomy is performed. 2. OXYTOCIN: Oxytocin (Pitocin) is commonly used to help contract the uterus after delivery, though its use may be limited in cases of placenta accreta or increta due to the risk of uterine rupture or hemorrhage. 3.UTEROTONICS: Drugs like misoprostol may be used to help control bleeding after delivery, although careful management is needed. 4. CORTICOSTEROIDS (IN CASE OF PRETERM LABOR): Betamethasone or dexamethasone may be given to promote fetal lung maturity if early delivery is planned.  Critical Thinking: QUESTION: In a patient diagnosed with placenta accreta, how should the healthcare team prepare for potential massive hemorrhage during delivery, and what key indicators should be monitored in the perioperative period to ensure prompt management of complications?  Critical Thinking: QUESTION: In a patient diagnosed with placenta accreta, how should the healthcare team prepare for potential massive hemorrhage after delivery, and what should be monitored in the Postoperative Monitoring period to ensure prompt management of complications?  Critical Thinking: ANSWER POSTOPERATIVE MONITORING: 1. Close monitoring of vital signs (blood pressure, heart rate, oxygenation) to detect signs of shock or blood loss. 2. Watch for signs of infection, especially if a hysterectomy is performed or if there is any retained placental tissue. 3. Electrolyte imbalances and renal function monitoring due to the possibility of large blood transfusions, which can affect kidney function. VASA PREVIA  WHAT IS VASA PREVIA? Vasa previa is a rare pregnancy complication that can lead to severe blood loss for your fetus if it’s not carefully managed. With vasa previa, unprotected blood vessels from the umbilical cord travel across the opening of your cervix (or cervical os). When your water breaks during labor, the exposed blood vessels can burst, causing severe blood loss for your fetus or even death. Diagnosing vasa previa early and delivering your baby via c-section can prevent these VASA PRAEVIA is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue. The term "vasa previa" is derived from the Latin; "vasa" means vessels and "previa" comes from "pre" meaning "before" and "via" meaning "way". Vasa praevia occurs in about 0.6 per 1,000 pregnancies. In other words, vessels lie before the fetus in the birth canal and in the way.  THERE ARE TWO TYPES OF VASA PREVIA: Type 1 (Velamentous Type 2 (Succenturiate Feature Insertion) Placenta) Blood vessels travel from Blood vessels originate the velamentous Origin of Blood Vessels from the succenturiate insertion (membranes of lobe of the placenta the placenta) Vessels from the Vessels cross the internal Location of Vessels succenturiate lobe cross cervical os unprotected the cervical os Succenturiate lobe Normal placenta with (additional lobe of Placental Structure velamentous cord placenta) with vessels from insertion it crossing over the cervix Higher risk of fetal Risk of fetal hemorrhage hemorrhage due to due to vessels from the Risk unprotected vessels and succenturiate lobe crossing possible rupture the cervix Identified on ultrasound Ultrasound or MRI through color Doppler  What is the difference between vasa previa and placenta previa? Placenta previa is a condition where your placenta sits low in your uterus so that it covers your cervix. Typically, your placenta attaches to the top or side of your uterus, away from your cervix. When your placenta is close to your cervix, the blood vessels that connect your placenta to your uterus can break and bleed once labor starts. A resolved placenta previa or low-lying placenta increases the risk of vasa previa.  How serious is vasa previa? Vasa previa is serious and can result in stillbirth. However, with a prenatal diagnosis, careful treatment and a scheduled cesarean birth (c-section), the survival rate is 98.6%. Management for both types of vasa previa focuses on preterm detection, careful monitoring of fetal well-being, and a planned cesarean delivery at 34-37 weeks (depending on the circumstances). A vaginal delivery is usually contraindicated due to the risk of fatal fetal hemorrhage from vessel rupture.  Who does it affect? You have velamentous cord insertion and bilobed/multilobed placenta. Your placenta attaches lower in your uterus so that it covers your cervix partially or entirely (placenta previa or low-lying placenta). You’ve had c-sections previously. You’re doing in vitro fertilization (IVF). You’re pregnant with multiples (twins or triplets). You’ve had previous surgeries on your uterus.  How common is vasa previa? Vasa previa is rare, occurring in approximately 1 in every 2,500 deliveries. Vasa previa occurs more often in pregnancies involving IVF, about 1 in every 200 deliveries.  Diagnosis and Tests Vasa previa is usually diagnosed during ultrasound exams at around weeks 18 to 26. If there are ultrasound risk factors for vasa previa such as bilobed placenta or velamentous cord insertion, your provider can do a transvaginal ultrasound to see if there are blood vessels from the umbilical cord near your cervical os. Your provider may use the color Doppler feature on the ultrasound, which shows blood flow more clearly. Your provider will note: Where the placenta is in relationship to your cervical os. Whether the placenta has multiple lobes. The location of the umbilical cord.  Management and Treatment If you’re diagnosed with vasa previa, your healthcare provider will schedule a c-section delivery. Your provider will monitor your pregnancy carefully to maximize the amount of time you’re pregnant while taking care to deliver the baby before you run the risk of going into labor. Your pregnancy plan may include: Non-stress tests. Your provider may schedule you for regular (around twice a week) non-stress tests. These tests assess your fetus’s heart rate and are completely safe for both you and the fetus. Corticosteroids. Your provider may prescribe corticosteroids to help the fetus’s lungs develop in preparation for a c-section delivery. Inpatient management. Your provider may recommend that you go to the hospital early so you can be closely monitored in the days leading up to delivery. Your provider will consider factors like your medical history, your likelihood of going into labor, and how far away you are from the hospital to decide if this is necessary. A scheduled c-section (weeks 34 to 37). Your provider will discuss the risks and benefits of delivery timing in order to reduce the risk of pregnancy complications associated with vasa previa. Many babies require treatment in the neonatal intensive care unit due to early delivery.  How do you fix vasa previa? You can’t fix vasa previa, but you can put a plan in place that improves your chances of successful delivery and a healthy baby. Speak to your healthcare provider about the best time to schedule your c-section so that delivery is safe for both you and the fetus. How can I reduce my risk of vasa previa? You can’t reduce your risk of vasa previa, but you can reduce your risk of experiencing the most serious complications by getting regular prenatal check-ups. An early diagnosis significantly improves the outcomes of vasa previa.  What can I expect if I have vasa previa? With vasa previa, you should expect a c- section instead of a vaginal delivery. And you should expect additional monitoring during your pregnancy. This additional care makes all the difference when it comes to delivering a healthy baby. PLACENTAL INSUFFICIENCY  Definition: a condition that occurs when the placenta doesn't provide enough nutrients and oxygen to the fetus. It can happen when the placenta doesn't develop properly or is damaged. S/Sx: Placental insufficiency can cause complications for both the parent and the fetus. It’s more life-threatening for the fetus. Maternal Symptoms: High blood pressure (hypertension) Swelling (edema) Protein in urine (in case of preeclampsia) Fetal Symptoms: Small for gestational age (SGA) or intrauterine growth restriction (IUGR) Decreased fetal movement Non-reassuring fetal heart rate patterns (e.g., variable decelerations)  Diagnosis and Tests: Ultrasound: To assess fetal growth and amniotic fluid levels. Doppler Flow Studies: Measures blood flow to the placenta and fetus. Non-Stress Test (NST): To monitor fetal heart rate and movement. Biophysical Profile (BPP): Combination of ultrasound and NST to evaluate fetal well-being.  Management and Treatment: Monitoring: Frequent ultrasounds and fetal heart rate monitoring Close maternal and fetal assessment Medications: Antihypertensive drugs (if needed for maternal hypertension) Corticosteroids (to enhance fetal lung maturity if preterm birth is anticipated) Delivery: Depending on severity, preterm delivery or induction of labor may be necessary.  Can you prevent placental insufficiency? Most times, you can’t prevent placental insufficiency. Getting early prenatal care is often the best thing you can do because it can allow a provider to detect it sooner. Early detection and management will reduce the chances of you experiencing complications during your pregnancy. Managing any preexisting or new health conditions can also go a long way in preventing additional complications. Retained Placenta Definition: is when some of the placenta stays in your uterus after your baby is born. Retained placenta happens in around 2 out of 100 births. If untreated, a retained placenta can lead to severe infection or life-threatening blood loss. Causes of a Retained Placenta: Failure of Placental Separation: Poor uterine contractions Uterine atony Placental Abnormalities: Placenta accreta, increta, or percreta Previous cesarean section or uterine surgeries Uterine Anomalies: Such as uterine fibroids or an abnormally shaped uterus. The most common reason for a retained placenta is not enough contractions in the uterus. Contractions can slow down or the uterus can have trouble contracting for different reasons. These include: Having large babies Giving birth many times Too much oxytocin medication A long labor A fast labor Fibroids Having twins/Multiple Magnesium sulfate infusions  Clinical Manifestations of Retained Placenta: Postpartum Hemorrhage: Heavy bleeding after delivery. Failure of Placental Expulsion: Placenta is not expelled within 30 minutes to 1 hour after delivery. Signs of Infection: If the retained placenta leads to infection (e.g., fever, foul-smelling discharge). Abdominal Pain: Often related to uterine contraction and bleeding.  Treatment for Retained Placenta: Some conditions can make it more likely that your uterus won’t contract properly. This can lead to a retained placenta. Your doctor will carefully check your medical history and consider how many births you’ve had and what kind of births. They might make plans during your pregnancy that can help ensure you won't have a retained placenta or prepare for retained placenta treatment.  Treatment for Retained Placenta: MANUAL REMOVAL: A procedure in which the placenta is manually removed under sterile conditions. SURGICAL REMOVAL: If manual removal fails, a surgical procedure (e.g., curettage or hysterectomy) may be required. UTEROTONICS: Medications like oxytocin to help the uterus contract and expel the placenta.  Treatment for Retained Placenta: BLOOD TRANSFUSIONS: In case of severe hemorrhage, blood transfusions may be necessary. ANTIBIOTICS: To prevent or treat infection if the retained placenta causes an infection. MASSAGE. After delivery, your doctor might massage your abdomen to help it contract. BREASTFEEDING. This is because breastfeeding makes your uterus contract and is a natural process that will help prevent a retained placenta. 15 minutes ….  Prepare the Paper: Take 1/2 sheet of paper (cut a full sheet in half). Write with Black Ballpen: Use a black ballpen only for your writing. No other ink colors are allowed. Strictly NO ERASURE.  Fill in the blank:1-10 1. A condition when the placenta attaches inside the uterus but in a position near or over the cervical opening. 2. A rare pregnancy complication that can lead to severe blood loss for your fetus if it’s not carefully managed. With vasa previa, unprotected blood vessels from the umbilical cord travel across the opening of your cervix (or cervical os). 3. The placenta is more deeply embedded in the uterine wall, attaching firmly to the uterine muscle. This type accounts for about 15% of cases. 4. The placenta passes through the uterine wall and may extend into nearby organs, such as the bladder or intestines. This is the most severe type and accounts for about 5% of cases. 5. a condition that occurs when the placenta doesn't provide enough nutrients and oxygen to the fetus. It can happen when the placenta doesn't develop properly or is damaged.  Fill in the blank:1-10 6. A condition is when some of the placenta stays in your uterus after your baby is born. 7. A placenta condition in which placental villi invade the surface of the myometrium 8. The premature separation of the placenta from the uterine wall before delivery. 9. A diagnostic procedure helpful adjunct, especially when the ultrasound findings are inconclusive. It provides a clearer image of the placental invasion and can help delineate the extent of the invasion. 10. A diagnostic combination of ultrasound and NST to evaluate fetal well- being.  Enumeration: 11-30 11-16: Placental complications can pose significant risks to both the mother and fetus. 17-19: Three variants of abnormally invasive placen implantation are recognized. 20-21: Two types of vasa previa  Enumeration: 11-30 22-25: Clinical Manifestations of Retained Placenta. 26-30: Give atleast 5 risk factors that can lead to ABRUPTIO PLACENTA  True or False:31-40 31. Placenta previa occurs when the placenta is implanted in the lower part of the uterus, partially or completely covering the cervix. 32. Placenta accreta occurs when the placenta is attached too deeply into the uterine wall, potentially leading to difficulty in placental separation after delivery. 33. Placental insufficiency is primarily caused by a maternal infection. 34. Placental insufficiency is always diagnosed with an ultrasound in the first trimester. 35. A common complication of placenta previa during labor is hemorrhage, which may necessitate a cesarean section for delivery.  True or False:31-40 36. If a patient with placenta previa is diagnosed early and the placenta is low-lying, vaginal delivery can be safely attempted. 37. Placenta previa can be diagnosed during routine prenatal ultrasounds, and management involves frequent monitoring and a planned cesarean section delivery. 38. A nurse caring for a patient diagnosed with vasa previa should prepare for immediate cesarean delivery if vaginal bleeding occurs. 39. In cases of abruptio placenta, the primary concern is fetal oxygenation, and the priority intervention is to administer oxygen to the mother. 40. Placental insufficiency, if left untreated, can result in intrauterine growth restriction (IUGR) and preterm birth.