LESSON PLAN

ON
placenta praevia

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 Name of the Teacher --- Mrs. Shwetha Rani C.M.

Class --- 2nd year Msc Nursing

Subject --- Obstetric and Gynecology Nursing

Topic --- Placenta Praevia

Group of the student --- 1st year M.Sc nursing

Time --- 1 hr

Date ---

AV Aids --- Black Board , Chart , O.H.P.

Medium of instruction --- English

Method of teaching --- Lecture cum Discussion

Previous knowledge of the group --- The group has less knowledge regarding uterine prolapse.

GENTRAL OBJECTIVES:

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 After this class the students will be able to acquire knowledge in depth regarding definition, etiology, clinical
features, diagnosis, complications, medical management of placenta praevia.

SPECIFIC OBJECTIVES:
 .Define placenta praevia and Explain the etiological factors of placenta praevia.
 Describe the clinical symptoms & diagnosis of placenta praevia
 List down the complications of placenta praevia
 Describe the management of placenta praevia

Sl.No Time Specific Contents Teacher’s Learner’s AV aids Evaluation

Objectives activity Activity

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1. 10 Define Writes the Listens Black What are the
min placenta PLACENTA PRAEVIA: topic on the attentively board causes of
Definition:
praevia and when the placenta is implanted black board. placenta
Explain partially or Completely over the Introduces praevia?
lower uterine segment it is called as
etiology of the topic by
placenta praevia
placenta explaining
praevia Incidence: definition &
etiology of
0.5 – 1% among hospital deliveries
placenta
80% cases – multiparous women
Age – 35 beyond praevia

Etiology:

 Dropping down theory

 Persistence of chorionic
activity
 Defective decidua
 Big surface of the placenta
2. 10 Describe the Explains the Listens Black Enumerate
min Predisposing types of attentively board the

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Factors and PREDIAPOSING FACTORS: degrees of predisposing
 Multiparity
types of  Increased maternal age placenta Factors and
degrees of  H/o Caesarian section praevia by various
 smoking
placenta using the degrres of
praevia black board placenta
Types of degrees:
praevia?
There are four types of placenta
praevia depending upon the degree
of extension of placenta to the lower
uterine segment.

TYPE -I(low-lying): the major part

of the placenta is attached to the
upper segment and only lower
margin encroaches on to the lower
segment but not upto the OS.
Type -II(marginal): the placenta
reaches the margin of the internal os
but does not cover it.
TYPE-III (incomplete or partial .
complete): the placenta covers the
internal os partially

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3. 15 Enumerate TYPE-IV(central or total): the Explains the Listens and Black Describe the
placenta completely covers the
min the clinical internal os even after it is fully clinical discusses board signs &
Features of dilated features attentively OHP symptoms of
Placenta Of placenta Placenta
Clinical features:
praevia praevia by praevia?

Symptoms: the only symptom is using black

bleeding board
the bleeding is painless, onset,
apparently causeless and reccurent.
Signs: anaemia due to blood loss

Abdominal examination:

 the size of uterus is

proportionate to the period of
gestation.
 The uterus feels relaxed, soft
and elastic without any
localised area of tenderness.
 Persistence of malpresentation
like breech,or transverse or

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 unstable lie.
 The head is floating in contrast
to the period of gestation
 Fetal heart sound is usually
present
Vulval inspection: character of
blood – bright red or dark red
coloured and the amount of blood
loss to be assessed from blood
stained clothings.
 In placenta praevia the blood
is bright red as the bleeding
occurs from the seperated
utero-placental sinuses close to
the cervical opening and
escapes out immediately
Vaginal examination – it must not
be done outside the operation theatre.
It can provoke further seperation of
4. 5 min List out the Explains the Listens OHP List down the
placenta with haemmorhage.
diagnosis of  It should only be done prior to diagnosis of attentively Black diagnosis of
Placenta termination of pregnancy in placenta board Placenta
the operation theatre under
praevia praevia by praevia?

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 anaesthasia. using OHP

Diagnosis:

I. PLACENTOGRAPHY:
 SONOGRAPHY
• Trans abdominal ultrasound
• Trans vaginal ultrasound
5. 5 min List down • Trans perineal ultrasound Explains the Listens OHP Enumerate
 MRI
complication . CLINICAL CONFIRMATION complication attentively complications
s of placenta  By internal examination s of placenta ofplacenta
 Direct visualization during
praevia caesserean section praevia by praevia?
 Examination of the placenta using OHP
following vaginal delivery

Complications:

MATERNAL: (during pregnancy)

 Antepartum haemmorhage
with varying degrees of shock
 Malpresentation
 Premature labour

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 During labour:
 Early rupture of the membranes
 cord prolapse
 Slow dilatation of the cervix
 Intrapartum haemmorhage
 Increased incidence of
operative interference
6. 15 Describe the Explains the Listens Black Explain the
 Postpartum haemorrhage
min medical  Retained placenta medical attentively board medical
management Puerperium: management and asks OHP management
 Sepsis
of  Subinvolution of doubts of placenta
Placenta  Embolism Placenta praevia?
FETAL:
praevia praevia
Low birth weight, asphyxia,
intrauterine death, birth injuries,
congenital malformations

Management:
PREVENTION:
 Adequate antanatal care
 Antanatal diagnosis of low

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 lying placenta at 20 th weeks

with routine ultrasonography

 Significance of “warning
haemorrhage”
 Family planning and limitation
of birth reduce the incidence
of placenta praevia

INTERVENTION:

An initial assessment to determine the

status of the mother and fetus is
required. Although mothers used to be
treated in the hospital from the first
bleeding episode until birth, it is now
considered safe to treat placenta
praevia on an outpatient basis if the
fetus is at less than 30 weeks of
gestation, and neither the mother nor
the fetus are in distress.

Immediate delivery of the fetus may

be indicated if the fetus is mature or if
the fetus or mother are in distress.
Blood volume replacement (to

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maintain blood pressure) and blood
plasma replacement (to maintain
fibrinogen levels) may be necessary.

It is controversial if vaginal delivery

or a Caesarean section is the safest
method of delivery. In cases of fetal
distress a Caesarean section is
indicated. Caesarian section is
contraindicated in cases of
disseminated intravascular
coagulation.

A problem exists in places where a

Caesarean section cannot be
performed, due to the lack of a
surgeon or equipment. In these cases
the infant can be delivered vaginally.
There are two ways of doing this with
a placenta praevia:

 The baby's head can be brought

down to the placental site (if
necessary with Willet's forceps
or a vulsellum) and a weight
attached to his scalp

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  A leg can be brought down and
the baby's buttocks used to
compress the placental site

The goal of this type of delivery is to

save the mother, and both methods
will often kill the baby. These
methods were used for many years
before Caesarean section and saved
the lives of both mothers and babies
with this condition.

The main risk with a vaginal delivery

with a praevia is that as you are trying
to bring down the head or a leg, you
might separate more of the placenta
and increase the bleeding.

Placenta praevia increases the risk of

puerperal sepsis and postpartum
haemorrhage because the lower
segment to which the placenta was
attached contracts less well post-
delivery.

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SUMMARY:
when the placenta is implanted partially or Completely over the lower uterine segment it is called as
placenta praevia. Predisposing factors like Multiparity, Increased maternal age, H/o Caesarian section, smoking .
If bleeding takes place, it is essential to obtain immediate care in a hospital Emergency Room. There are two
standard courses of treatment: immediate delivery by cesarean or "expectant management" strict, in-hospital
bedrest and frequent monitoring until the baby is mature enough to live without a respirator outside the uterus.

CONCLUSION:
At the end of the class the student have gain knowledge about definition, etiology, clinical features, diagnosis,
complications, medical management of placenta praevia.

BIBLIOGRAPHY :
1) Myles. “Text book for midwives”.7th edition 2004; Churchill livingstone.
Page no – 178-180
2) D.C.Dutta. Text book of Obstetrics. 6 th ed 2004; New central book agency.

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 Page no-243-54

EVALUATION:
SHORT ASSAY TYPE QUESTION 2X5=10
1) Define placenta praevia and explain in detail the clinical course of it?

2) Describe the various types of degrees of placenta praevia?

An assignment:
1)explain an nursing management of placenta praevia?

Bibliography:
1). D.C.Dutta. Text book of Obstetrics. 6 th ed 2004; New central book agency.

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