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Abruptio Placenta

Description

  • Abruptio placenta is premature separation of a normally implanted placenta after the 20th week of pregnancy, typically with severe hemorrhage.

Etiology

1. The cause of abruptio placenta is unknown.

2. Risk factors include:
  • Uterine anomalies
  • Multiparity
  • Preeclampsia
  • Previous cesarean delivery
  • Renal or vascular disease
  • Trauma to the abdomen
  • Previous third trimester bleeding
  • Abnormally large placenta
  • Short umbilical cord

Pathophysiology

  • The placenta detaches in whole or in par from the implantation site. This occurs in the area of the deciduas basalis.

Assessment Findings

1. Associated findings. Severe abruption placentae may produce such complications as:

a. Renal failure
b. Disseminated intravascular coagulation
c. Maternal and fetal death

2. Common clinical manifestation include:

a. Intense, localized uterine pain, with or without vaginal bleeding.
b. Concealed or external dark red bleeding
c. Uterus firm to boardlike, with severe continuous pain
d. Uterine contractions
e. Uterine outline possibly enlarged or changing shape
f. FHR present or absent.
g. Fetal presenting part may be engaged.

3. Laboratory and diagnostic study findings.
  • Ultrasound may be able to identify the extent of abruption. However, the absence of an ultrasound finding does not rule out the presence of abruption.

Nursing Management

1. Continuously evaluate maternal and fetal physiologic status, particularly:
  • Vital signs
  • Bleeding
  • Electronic fetal and maternal monitoring tracings
  • Signs of shock-rapid pulse, pallor, cold and most skin, decrease in blood pressure
  • Decreasing urine output
  • Never perform a vaginal or rectal examination or take any action that would stimulate uterine activity.

2. Assess the need for immediate delivery. If the client is in active labor and bleeding cannot be             stopped with bed rest, emergency cesarean delivery may be indicated.

3. Provide appropriate management.
  • On admission, place the woman on bed rest in a lateral position to prevent pressure on the vena cava.
  • Insert a large gauge intravenous catheter into a large vein for fluid replacement. Obtain a blood sample for fibrinogen level.
  • Monitor the FHR externally and measure maternal vital signs every 5 to 15 minutes. Administer oxygen to the mother by mask.
  • Prepare for cesarean section, which is the method of choice for the birth.
4. Provide client and family teaching.

5. Address emotional and psychosocial needs. Outcome for the mother and fetus depends on the          extent of the separation, amount of fetal hypoxia, and amount of bleeding.

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