the national ribat university college of graduate studies...

The National Ribat University

College of Graduate Studies and Scientific Research

Faculty of nursing sciences

Assessment of nurses Knowledge for nursing care

of women have placenta previa , in antenatal

ward at Rib at University hospital

A thesis submitted in partial Fulfillment for

Requirement of Master Degree of the In Obstetric

and Gynecological Nursing

Submitted by:

Leila Abdullah Hamza

Supervised By:

Dr. Sedeig Alrwa




ةـــاآلي

بسم هللا الرحمن الرحيم

قال تعالى ِإنَّا َخَلْقَنا اإِلنَساَن ِمن نُّْطَفٍة َأْمَشاٍجِ )

(َسِميًعا َبِصيًران َّْبَتِليِه َفَجَعْلَناُه

صدق اهلل العظيم

( 2)االية االنسان سورة




Dedication

I would like to dedicate this study

To

Spire of my parents.

To

My: my daughter and my husband.




And

WY: brothers and my sisters my friends.

Acknowledgment

My thanks to my supervisor Dr. Sediege Alrwa for his

helpful supervision , valuable advice and support .

Also my thankful for the great help and cooperation of

nurses working in antenatal ward at Ribat

university hospital




بحثال الخالصة

الفترة من في رباط الجامعى تعرضة في مستشفى الأجريت هذه الدراسة الوصفية المسدى معرفة الممرضات االئ يعملن فى عنبر م لتقييم 2102الى مايو 1022دسمبر

.الحوامل بمستشفى الرباط الجامعى

ن جمعت البيانات من المشاركات بواسطة استبيا لممرضات من ا 45كان عدد العينة

. ممرضاتال منظم مليء بواسطة

. الحزمة اإلحصائية للعلوم االجتماعية برنامج بواسطة إحصائيا وتم تحليل البيانات




بان االم الحامل ولديها جيدة ةمعرفلديهن مرضاتمن الم% 200اسة وجدت الدار

.تحسب انها لديها مشكلة فى الوالدةحالصة متقدمة

للممرضات الئ يعملن فى عنبر الحوامل جيدة ةمعرفصت الدارسة إلى ان هناك خل

كيفة تمريض االم الحامل التى خالصة متقدمة حول بمستشفى الرباط الجامعى

ومن خالل تلك الدراسة التى تم عملها نوصى بتجديد وزيادة معرفة الممرضات االئ يعملن فى عنبر الحوامل بمستشفى الرباط الجامعى عن

وورشات الكورسات محاضرات,سمنارات,التدريب عن طريقطريق عمل

العمل.

Abstract

Purpose: To assess’ knowledge of nurses how are working in

antenatal ward at Ribat university hospital about how to care to the

women with placenta previa.

Methodology: Descriptive cross-sectional hospital based study

conducted in Ribat university Hospital in the duration from

December 2011 to May 2012.




54 nurses working in antenatal ward at Ribat Hospital were

interviewed using asking questionnaire by researcher. Data were

analyzed by statistical package for social sciences program,

Results: These study findings showed that most of the nurse's 54-

(100%) nurses agree placenta previa is Obstetric complication.

Conclusion: nurses’ knowledge is good, but there should be

intensive effort to improve the knowledge and awareness within

graduated nurse about how to provide care, close monitoring to

women with placenta previa .this could be through: lectures

workshops, seminars, training course. .

-

Table of contents

I……...…………………………………………………االية




Dedication ………………………………………………II

Acknowledgment………………………………..………III

البحث خالصة ………………………………………………IV

Abstract…………………………………….…………….V

Table of contents………………………………………VI

Chapter 1 Introduction + objectives 1-2

Chapter II Literature review 3-25

Chapter III Material &Methodology 26-27

Chapter VI Result 28-51

Chapter V Discussion 52-53

Chapter VI Conclusion & Recommendation 54

Chapter VII Appendix & Referen 55-59




References




Chapter VII

Appendix &References




Appendix




Chapter VI

Conclusion and recommendation




Chapter V

Discussion




Chapter IV




RESULT




Literature review




Chapter I

Introduction

Chapter one

Introduction

Placenta previa is a condition in which the placenta is implanted in the

lower segment of the uterus so that it is adjacent to or obstructs the internal

opening of the cervix. It may cause maternal hemorrhage prior or during

labor. Also called placenta presentation.




1-1-General objectives

To assess knowledge of nurses for how to give nursingcare forewomen with

placenta previa.

1-2 Specific objectives

-To assess knowledge of nurses car given to women with placenta previa.

-To assess knowledge of nursesto prevent potential complications of women

with placenta previa.

1-3 Justification

This study assessed knowledge of nurses for how to give

nursing care for women with placenta previa.Itwas important

because its associated with serious complication for maternal

and fetal life.

Chapter two

Literature review




Placenta

2-1-Definition

The placenta is an organ that connects the developing fetus to the

uterine wall to allow nutrient uptake, waste elimination, and gas

exchange via the mother's blood supply. Placentas are a defining

characteristic of "placental "mammals. [1]

2-2- Structure

2-3- Developments

2-4-Placental circulations (Maternal placental circulation

fetoplacental circulation).

2.5- Functions (Nutrition and immunity Endocrine function)

2-2-Structure

In humans, the placenta averages 22 cm (9 inch) in length and 2–2.5 cm

(0.8–1 inch) in thickness (greatest thickness at the center and become thinner

peripherally). It typically weights approximately 500 grams (1 lb). It has a

dark reddish-blue or maroon color. It connects to the fetus by an umbilical

cord of approximately 55–60 cm (22–24 inch) in length that contains two

arteries and one vein. [3]

The umbilical cord inserts into the chorionic plate (has an eccentric

attachment). Vessels branch out over the surface of the placenta and further

divide to form a network covered by a thin layer of cells. This results in the

formation of villous tree structures. On the maternal side, these villous tree

structures are grouped into lobules called cotyledons. In humans, the




placenta usually has a disc shape, but size varies vastly between different

mammalian species. [4]

2-3-Development

The placenta begins to develop upon implantation of the blast cyst into the

maternal endometrial. The outer layer of the blast cyst becomes the

trophoblastic, which forms the outer layer of the placenta. This outer layer is

divided into two further layers: the underlying cytotrophoblast layer and the

overlying syncytiotrophoblast layer. The syncytiotrophoblast is a

multinucleated continuous cell layer that covers the surface of the placenta.

It forms as a result of differentiation and fusion of the underlying

cytotrophoblast cells, a process that continues throughout placental

development. The syncytiotrophoblast (otherwise known as syncytium),

thereby contributes to the barrier function of the placenta.

The placenta grows throughout pregnancy. Development of the maternal

blood supply to the placenta is suggested to be complete by the end of the

first trimester of pregnancy (approximately 12–13 weeks).

2-4-Placental circulation

Maternal blood fills the intervillous space, nutrients, water, and gases are

actively and passively exchanged, then deoxygenated blood is displaced by

the next maternal pulse.

-Maternal placental circulation

In preparation for implantation, the uterine endometrial undergoes

'decasualization'. Spiral arteries in deciduas are remodeled so that they

become less convoluted and their diameter is increased. The increased

diameter and straighter flow path both act to increase maternal blood flow to

the placenta. The relatively high pressure as the maternal blood fills




intervillous space through these spiral arteries bathes the fetal villi in blood,

allowing an exchange of gases to take place. In humans and other

hemochorialplacentals, the maternal blood comes into direct contact with the

fetal chorine, though no fluid is exchanged. As the pressure decreases

between pulses, the deoxygenated blood flows back through the endometrial

veins.

Maternal blood flow is approx 600–700 ml/min at term.

-Fetoplacental circulation

Deoxygenated fetal blood passes through umbilical arteries to the placenta.

At the junction of umbilical cord and placenta, the umbilical arteries

branch radically to form chorionic arteries. Chorionic arteries, in turn,

branch into cotyledon arteries. In the villi, these vessels eventually branch to

form an extensive arteriocapillary venous system, bringing the fetal blood

extremely close to the maternal blood; but no intermingling of fetal and

maternal blood occurs ("placental barrier")[5]

Endothelia and prostanoids cause vasoconstriction in placental arteries,

while nitric oxide vasodilatations. On the other hand, there is no neural

vascular regulation, and catecholamine's have only little effect. [6]

2-5-Functions

The placenta functions as a fetomaternal organ with two components: the

fetal placenta, or (Chorine frond sum), which develops from the same sperm

and egg cells that form the fetus; and the maternal placenta, or (Decidua's

basalts), which develops from the maternal uterine

Tissue. {2}

-Nutrition and immunity




The perfusion of the intervillous spaces of the placenta with maternal blood

allows the transfer of nutrients and oxygen from the mother to the fetus and

the transfer of waste products and carbon dioxide back from the fetus to the

maternal blood supply. Nutrient transfer to the fetus occurs via both active

and pas save transport. Active transport systems allow significantly different

plasma concentrations of various large molecules to be maintained on the

maternal and fetal sides of the placental barrier. [7]

Adverse pregnancy situations, such as those involving maternal diabetes or

obesity can increase or decrease levels of nutrient transporters in the placenta resulting in overgrowth or restricted growth of the fetus [citation

needed].

Immune globin (antibodies can pass through the human placenta) thereby

providing protection to the fetus in utero. [8]

-Endocrine function.

In humans, aside from serving as the conduit for oxygen and nutrients for

fetus, the placenta secretes hormones (secreted by syncytial

layer/syncytiotrophoblast of chorionic villi) that are important during

pregnancy.

-Hormones

Human Chorionic gonadotropin (HCG.): The first placental hormone

produced is HCG, which can be found in maternal blood and urine as early

as the first missed menstrual period (shortly after implantation has occurred)

through about the 100th day of pregnancy. This is the hormone analyzed by

pregnancy test; a false-negative result from a pregnancy test may be

obtained before or after this period. Women's blood serum will be

completely negative for HCG by one to two weeks after birth. HCG testing




is proof that all placental tissue is delivered. HCG is present only during

pregnancy because it is secreted by the placenta, which is present only [9]

During pregnancy. HCG also ensures that the corpus lutium continues to

secrete progesterone and estrogen. Progesterone is very important during

pregnancy because, when its secretion decreases, the endometrial lining will

slough off and pregnancy will be lost. HCG suppresses the maternal

immunologic response so that placenta is not rejected.

Human Placental Lactogenic (HPL). This hormone is lactogenic and growth-

promoting properties. It promotes mammary gland growth in preparation for

lactation in the mother. It also regulates maternal glucose, protein, and fat

levels so that this is always available to the fetus.

Estrogen is referred to as the "hormone of women" because it stimulates the

development of secondary female sex characteristics. It contributes to the

woman's mammary gland development in preparation for lactation and

stimulates uterine growth to accommodate growing fetus.

Progesterone is necessary to maintain endometrial lining of the uterus during

pregnancy. This hormone prevents preterm labor by reducing myometrium

contraction. Levels of progesterone are high during pregnancy

The placenta and fetus may be regarded as a foreign allograft inside the

mother, and thus must evade from attack by the mother's immune system.

For this purpose, the placenta uses several mechanisms:

It secretes Neurontin blood containing phosphocholine molecules. This is

the same mechanism used by parasitic nematodes to avoid detection by the

immune system of their host. [10]




However, the placental barrier is not the sole means to evade the immune

system, as foreign fetal cells also persist in the maternal circulation, on the

other side of the placental barrier. [11]

The end of the second week is characterized by the first appearance of

chorionic villi. The layer of the placenta from which the villi project is

called the chorionic plate. Primary villous stems have a central core of cells

derived by the proliferation of the cytotrophoblast. The primary villi

gradually develop mesenchyme cores, which convert them into the

secondary villi. The mesenchyme cells within the villi differentiate into

blood capillaries, thus forming the tertiary villi. The vessels from the villi

soon become connected with the embryonic heart via vessels that

differentiate in the mesenchyme of the chorine and in the connecting stalk.

Placental (tertiary) villi - 2nd month

By the end of the third week, embryonic blood is circulating through the

capillaries of the villi. As the growth continues, the villi on the decidua

capsular is (a embryonic) pole degenerate to form the chorine leave, while

the villi adjacent to the deciduas plate rapidly grow and expand to form the

chorine frond sum. The chorine frond sum forms up the placenta together

with the deciduas plate.

By the end of the fourth month of the pregnancy, the placenta has attained its

definitive form and undergoes no further anatomical modifications. It has

two components: the maternal portion, formed by the deciduas plate, and a

fetal portion, made by the chorine frond sum. Growth continues by further

ramification of the placenta stem villi into the surrounding intervillous




spaces. On the maternal side deciduas septa extend into the intervillous

spaces, dividing placenta into 10-38 cotyledons.

The villous surface area continues to increase until term, although the rate of

the increase slows from approximately 34 to 36 weeks of gestation. The has

a circular shape and measures about 15 to 20 cm in diameter, weighing 500

to 600 g at full term.

The umbilical cord is a vascular cable (55 cm) that connects the embryo to

placenta. The umbilical cord of the fetus is covered by the amniotic

epithelium and contains two umbilical arteries and one umbilical vein.




Placenta previa

Definition

Placenta previa is a complication of pregnancy when the placenta was

implanted in lower segment of the uterus and covers part or all cervix.

Placenta previa can cause significant bleeding before or during delivery. If

the placenta prematurely separates from the wall of the uterus, there is a risk

of significant vaginal bleeding. This could pose a significant risk to the

mother and fetus. Some women with thiscondition neededadmission to

hospital condition.

Prevalence

Placentaprevia was 2.8 in 1000 births for singleton pregnancies (pregnant

with only one baby) and 3.9 in 1000 births for twin pregnancies.Placenta

previa occurs in 1 out of 200 pregnancies.

While the condition is a serious complication in pregnancy, with early

diagnosis and proper management, there is a positive prognosis associated

with placenta previa.

Types of placenta previa

Marginal: The placenta is against the cervix but does not cover the

opening.

Partial: The placenta covers part of the cervical opening.

Complete: The placenta completely covers the cervical opening.

Causes




During pregnancy, the placenta moves as the uterus stretches and grows. In

early pregnancy, a low-lying placenta is very common. But as the pregnancy

progresses, the growing uterus should "pull" the placenta toward the top of

the womb. By the third trimester, the placenta should be near the top of the

uterus, leaving the opening of the cervix clear for the delivery.

Abnormally developed uterus

Many previous pregnancies

Multiple pregnancy (twins, triplets, etc.)

Scarring of the uterine wall caused by previous pregnancies,

cesareans, uterine surgery, or abortions

Women who smoke or have their children at an older age may also have an

increased risk. Possible causes of placenta previa include:

Abnormal formation of the placenta

Abnormal uterus

Large placenta

Scarred lining of the uterus (endometrial)

However, doctors are now able to use TransvaginalSonography (TVS) to

accurately measure the distance from the internal opening of the cervix to

the edge of the placenta, which makes the diagnosis more accurate. The gold

standard for the diagnosis of placenta previa has

becomeTransvaginalSonography and doctors classify the severity of placenta

previa by the distance of the cervix to the edge of the placenta or the degree

of overlap.

Prediction of Persistent Placenta Previa




In early pregnancy, a partial placenta previa can often self-correct as the

uterus enlarges and the placenta appears to migrate up in the uterus as the

lower segment thins out. This placental shift can continue up into the late

third trimester. The likelihood of placenta previa persisting until delivery is

dependent on the gestational age and the degree of overlap.

At 18-24 weeks’ gestation, if the placental edge reaches or overlaps the

cervical opening then a follow-up examination in the third trimester is

recommended. Overlap of more than 15 mm is associated with a high

likelihood of placenta previa persisting until term needing delivery by

Caesarean section {13}

After 26 weeks’ gestation, overlap of more than 20 mm indicates that

ultrasound should be repeated at regular intervals. Continued change is

placental location is likely but overlap greater than 20mm in the third

trimester is highly predictive for the need for a Caesarean section.

Symptoms

Painless, bright red vaginal bleeding toward the end of the second trimester

and near the beginning of the third trimester usually accompanies placenta

previa. The bleeding may range from light to heavy and may be

accompanied by uterine cramping. It tends to be episodic but typically recurs

within a few days or weeks. Many women with placenta previa may not

bleed at all.

The lower part of the uterus stretches during the second half of pregnancy. If

the placenta is attached to the lower segment of the uterus, this stretching

may cause the placenta to become partially detached causing vaginal

bleeding.

Uncontrolled bleeding (hemorrhage) is life threatening for both mother and

baby but with early and more accurate diagnosis this condition is no longer




as big a threat to the mother and baby. The biggest concern associated with

placenta previa is now premature birth.

Diagnosis

Diagnosis of placenta previa is suspected whenever bright red, painless

vaginal bleeding occurs during the course of a pregnancy. The diagnosis

can be confirmed by performing an ultrasound examination. This will allow

the location of the placenta to be evaluated.

While many conditions during pregnancy require a pelvic examination, in

which the health care provider's fingers are inserted into the patient's vagina,

such an examination should never be performed if there is any suspicion of

placenta previa. Such an examination can disturb the already susceptible

placenta, resulting in hemorrhage.

Sometimes placenta previa is found early in a pregnancy, during an

ultrasound examination performed for another reason. In these cases, it is

wise to have a repeat ultrasound performed later in pregnancy (during the

last third of the pregnancy, called the third trimester). A large percentage of

these women will have a low-lying placenta, but not a true placenta previa

where some or all of the os is covered

Management

Treatment depends on:

The amount of bleeding

Whether the baby is developed enough to survive if delivered

How much of the cervix is covered

The baby's position

The number of previous births you have had

Whether you are in labor




If the placenta is near or covering a part of the cervix, mother doctor may

recommend:

Reducing your activities

Bed rest

Pelvic rest, which means no sex, no tampons, and no douching

Nothing should be placed in the vagina.

Mother may need to stay in the hospital so mother health care team can

closely monitor for mother and her baby {14}.

If mother have lost a lot of blood, she may receive:

Blood transfusions

Medicines to prevent early labor

Medicines to help pregnancy continue to at least 36 weeks

Steroid shots to help the baby's lungs mature

Mother health care providers will carefully consider the risk of bleeding

against early delivery of her baby. After 36 weeks, delivery of the baby may

be the best treatment.

An emergency caesarean section may be done if the bleeding is heavy and

cannot be controlled.

Nearly all women with placenta previa need a caesarian section. If the

placenta covers all or part of the cervix, vaginal delivery can cause severe

bleeding. This can be deadly to the mother and her baby.

Incidence




Placenta previa is estimated to occur in 2.8 in 1000 births for singleton

pregnancies (pregnant with only one baby) and 3.9 in 1000 births for twin

pregnancies.

Prognosis

Women with placenta previa need to be carefully monitored by a health care

provider. Careful monitoring and delivery by caesarian section help prevent

most complications.

The biggest risk is severe bleeding that can be life threatening to the mother

and her baby. If mother have severe bleeding, her fetal may need to be

delivered early, before major organs, such as the lungs, have developed.

Complications:

-Risks to the Mother

Death

Major bleeding (hemorrhage)

Shock

There is also an increased risk for infection, blood clots, and necessary blood

transfusion

-Risk for the fetal

Prematurity (infant is less than 36 weeks gestation) causes most infant

deaths in cases of placenta previa. The baby may lose blood if the placenta

http://health.nytimes.com/health/guides/disease/premature-infant/overview.html




separates from the wall of the uterus during labor. The baby also can lose

blood when the uterus is opened during a Caesarean section deliver {15}.

Nursing care plan

Assessment

-Bleeding

-fluid deficit

-Abdomen

-vitals sing

-infection

-intake and out put




Nursing diagnoses Plan Intervention

-Bleeding(amount-color-

duration)

-fluid deficit

-Abdomen

Vital sign (BP)

-infection

-intake and out put

-avoid loss of blood

-avoid loss of fluid

-Avoid internal

bleeding

-to keep pt. in good

condition

-to keep pt. free from

infection

-fluid &electrolyte

balance

Check vital signs- amount &

Wight of pads-color &amount of

blood

Intake and output chart-color of

urine

- tenderness or rigidity- if

present, measure abdomen

-measure frequently to detect

early hypotension

Check CBC if TWB-HB low

ménage it by DR order

Encourage oral intake

according fluid loss Iv fluid if

needed (by DR order)




Chapter three

Material & Methodology

3-1-Study design:

Descriptive cross sectional hospital based study.

3-2-Study area:

Ribat university hospital –antenatal ward.

3-3-Study period:

Period from October 2011 to ARIL 2012.

3-4-Study population:

All nurses working in antenatal ward in rib at university hospital.

Sample size:




Full converge of the 54 nurses in antenatal ward of Ribat university hospital.

3-5-Data collection:

Data was collected by questionnaire filled –in population of the study.

3-6-Data presentation and analysis:

The answers of questionnaire by nurses are presented in tables and

percentages that used as an analytical technique to assess the different

elements of the knowledge ofnurses

Figures are also used to present final result.

Chapter four

Result

1-Table one show 54-100%nurses agrees placenta previa was Obstetric

complication

2- Table two shows49-90.7% nurses agree and 4-7.4% disagrees and1-

1.9%miss

Placenta previaoccurring insecond or third trimester

3-Table three shows that 46-85.2%nurses agree and 7-13% disagrees and 1-

1.9%missesCause antepartum hemorrhage

4-Table five show that 42-77.8%nurses agrees and 11-20.4% disagrees and

1miss placenta previa has four types

5- Table six show that 50-92.6%nurses agrees and 3- 5.6% disagrees 1miss

placenta previa recommended caesarean section




6- Table seven show that 41-75% nurses agree and 12-22.2% disagrees and

1miss Placenta previa occurring every 250 of birth

7- Table eight shows that40-74.9% nurses agrees 14-25.9% disagrees

curettage& dilatation, previous caesarean section causes placenta previa.

8-Table nine show that 42-77.8% nurses agree and 9-16.7% disagree and 1-

5.6% miss pain less and vaginal bleeding symptom of placenta previa.

9- Table ten show 49-88.9%nurses agrees and 4-9.4%not agrees women

with placenta previa needed to treat in hospital from first bleeding.

10- Table eleven show that 48-88.9%nurses agree and 5-9.3% disagrees and

1-1.9% miss women pregnant with twins have risk of placenta previa.

11- Table twelve show that 44-81.5%nurses agree and 9-16.7% disagrees

and 1-1.9%

12-table thirteen show that 30-55.6%nurses agree and 21-38.9% disagrees

and 3-5.6%miss women with placenta previa have bad prognosis for them

and their baby.

Statistics

obs_complica

tion

occuring_in_t

rimester

cause_antpart

um

aff_b_labou

r

tr_surg_effec

t

N

Valid 54 53 53 52 54

Missing 0 1 1 2 0

Statistics




has_4_types recommend_c

esare

ocuuring_ever

y_250b

W_DC_CS INI_ASS_OF

MOTH

N

Valid 53 53 53 54 51

Missing 1 1 1 0 3

Statistics

HOP_TR_UNTIL

_B

W_LARG_P_HIG

H_RISK

W_35Y_PPREVI

A_RISK

F_P_W

N

Valid 53 53 53 51

Missing 1 1 1 3

Frequency Table

Frequency Percent Valid

Percent

Cumulative Percent

Valid Yes 54 100.0 100.0 100.0

Table (1) Obstetric complication

Table( 1) show 54-100% nurses agree that placenta previa cause obstetric complication




Frequenc

y

Percent Valid

Percent

Cumulative

Percent

Valid

No 4 7.4 7.5 7.5

Yes 49 90.7 92.5 100.0

Total 53 98.1 100.0

Missing System 1 1.9

Total 54 100.0

Table (2) Occurring in third trimester

Table (2) show that 49-90.7%of nurses agree placenta previa occur in second or third

trimester

Frequenc

y

Percent Valid

Percent

Cumulative

Percent

Valid




Yes 53 98.1 98.1 100.0

Missing System 1 1.9 1.9

Total 54 100.0

Table (3) Cause antepartum hemorrhage

Table (3) show that 53-98.1%of nurses agree placenta previa cause antepartum hemorrhage

Frequenc

y

Percent Valid

Percent

Cumulative

Percent

Valid

No 11 20.4 20.8 20.8

Yes 42 77.8 79.2 100.0

Total 53 98.1 100.0


Total 54 100.0

Table (5) Placenta previa had four types

Table (5) show that 42-77.8% of nurses agree placenta previa had four types




Frequency Percent Valid

Percent

Cumulative Percent

Valid

No 3 5.6 5.7 5.7

Yes 50 92.6 94.3 100.0

Total 53 98.1 100.0

Missin

g

Syste

m 1 1.9

Total 54 100.0

Table (6)in placenta previa recommended delivery caesarean section

Table (6) show that 50-92.6% of nurses agree that placenta previa

recommended deliver by caesarean section

Frequency Percent Valid Percent Cumulative Percent

Valid

No 12 22.2 22.6 22.6

Yes 41 75.9 77.4 100.0

Tota

l 53 98.1 100.0

Missing Syst

em 1 1.9

Total 54 100.0

Table (7) Placenta previa occurring every 250 of birth




Table (7) show that 41-75.9 of nurses agree that placenta previa occurring every 250 of birth


Valid

NO 14 25.9 25.9 25.9

YE

S 40 74.1 74.1 100.0

Tot

al 54 100.0 100.0

Table (8) Curettage& dilatation, previous caesarean section risk factor for placenta

previa

Table (8) show that 40-74.1% of nurses agree that women with placenta previa had

previous curettage &dilatation or caesarean section

Frequency Percent Valid Percent Cumulative

Percent

Valid

NO 9 16.7 17.6 17.6

YES 42 77.8 82.4 100.0

Total 51 94.4 100.0

Missing Syste

m 3 5.6




Total 54 100.0

Table(9)Pain lees&vaginal bleeding are symptom of placenta previa

Table (9) show that 42-77.8%of nurses agree placenta previa had pain les

Frequenc

y

Percent Valid

Percent

Cumulative Percent

Valid

NO 4 9.3 9.4 9.4

YES 49 88.9 90.6 100.0

Total 53 98.1 100.0


Total 54 100.0

Table (10) Women with placenta previa need to be treat in hospital from first

bleeding

Table (10) show that 49-88.9%of nurses agree that women with placenta previa needed to

treat in hospital from first bleeding




Frequenc

y

Percent Valid

Percent

Cumulative Percent

Valid

NO 5 9.3 9.4 9.4

YES 48 88.9 90.6 100.0

Total 53 98.1 100.0

Missing

System 1 1.9

Total 54 100.0

Table(11) Women pregnant with twins have risk of placenta previa

Table (11) show that 48-88.9 of nurses agree that wman pregnant with twince she had

risk of placenta previa


Valid

NO 9 16.7 17.0 17.0

YES 44 81.5 83.0 100.0

Tota

l 53 98.1 100.0

Missing Syst

em 1 1.9

Total 54 100.0

Table (12) Placenta previa has abad prognoses for mother and fetus




Table (12) show that 44-81.5% of nurses agree that placenta previa was had bad prognosis


Valid

NO 21 38.9 41.2 41.2

YES 30 55.6 58.8 100.0

Tota

l 51 94.4 100.0

Missing Syst

em 3 5.6

Total 54 100.0

Table (13) Women more than thirty years have risk for placenta previa

Tale (13) show that women more than thirty years have risk for placenta previa

Bar Chart




Chapter five

Discussion

1-54% thinks that placenta previa cause obstetric complication which

indicates that 46% are unaware about this issue.

2- 90% of the respondent agree it occur in the third trimester of pregnancy

which a high ratio.

3-85% agrees it cause ant partum against 31%

4- 66% agrees that it affect 5% of birth labour.

5-74% agrees that it caused by trauma or surgery.

6-77% thinks it has four types.

7-92% thinks that women with placenta previa recommend delivery by

cesarean section.

8-75% agrees that placenta previa occur every 250 birth age.

9-74% agrees that women with placenta previa have previous dilatation and

curettage caesarean section.

10- 94% agrees that woman with placenta previa needed assessment.




11- 88% agrees that women with placenta previa needed hospital treatment.

12-88% agrees that women with twin (large placenta) have high risk of

placenta previa 13- 81% agree that women above 35 years have risk of

placenta previa.

13- 55% agrees that it is the first pregnancy for women.

Chapter six

Conclusion and recommendation

6-1 Conclusion

This cross –

sectional hospital based study which was conducted to assess the

knowledge, of 54 nurses who gave nursing care for women in antenatal

ward at Ribat University: concluded that.

Nurses’ knowledge was good, but they require improving this knowledge.

6-2 Recommendations

A according to these results there should be intensive effort to improve the

knowledge and awareness within graduated nurse about how to provide

care ,close monitoring to women with placenta previa .this could be through

:




-Lectures.

- Workshops.

-seminars

-Training course

Chapter seven

Questionnaire

1-placenta previait obstetric complication ?

Yes No

2-Was woman with placenta previa recommended by bed rest?

Yes No

3-placenta previa lead cause of ant partum hemorrhage?

Yes

4-was woman with placenta previa decrease her activity to avoid bleeding?

Yes NO

5-placenta previa has four types?




Yes NO

6-woman with placenta previa recommended secearinsection?

Yes NO

7-if woman is not bleeding severely she can be manage non-operate unit in

36thweeks?

Yes NO

8- Placenta previa occur approximately one of every 250 birth?

Yes No

9-was the woman with placenta previa has previous D&C or caesarean

section?

Yes No

10- Pain less and vaginal bleeding is symptom of placenta previa?

Yes No

11- Was mother needed to treat in hospital from the first bleeding episode

until birth?

Yes NO

12-was woman with large placenta from twice are at higher risk?

Yes No




13-Was woman more than 30 years risk for placenta previa?

Y No

14-was the diagnose f placenta previa is bad prognosis for the mother and

fetal?

Yes No

References

1-Myles edition 14 Diane M. Fraser Margareta. Cooper

Foreword by Gillian Fletcher

2-a b Kiered, T.; A chary, G. (2004).




3- Wright, Caroline; Sibley, Colin P. (2011).

4-Semester, N.E., and Story, C.M. 1997.

5- Politer, Adele (2010). Maternal and Child Health Nursing (6th Edition

[Philippine Edition]): Lippincott Williams & Wilkins

6- . BBC News. 10 November 2007.

7- Williams Z, Zapf D, Long tine J, et al. (March 2008).

8- Assad, RS; Lee, FY; Hanley, FL (2001).

9-Prendiville, W. J.; Melbourne, D.; McDonald, S. J.; Begley, C. M.

(2000).Begley, Cecily M. 7. Edit

11-. BBC. 18 April 2006. Retrieved 8 January

12- Francisco, Edna (3 December 2004). "".Minority Scientists

Network.Retrieved 7 January 2008.

13- Elsevier Churchill Livingstone; 2007.

14- Mosby Elsevier; 2006.

15- Williams Obstetrics. 22nd Ed. New York, NY; McGraw-Hill; 2005.

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