ABRUPTIO PLACENTAE

Abruption placentae is premature separation of normally implanted placenta after the 20th week of pregnancy, typically with severe hemorrhage

a. Description

1. The cause of abruptio placentae is unknown2. Risk factors include:

a. Uterine anomaliesb. Multiparityc. Preeclampsiad. Previous cesarean birthe. Renal or vascular diseasef. Trauma to the abdomeng. Previous third trimester bleedingh. Abnormally large placentai. Short umbilical cord

b. Etiology

The placenta detaches in whole or in part from the implantation site. This occurs in the area of the decidua basalis

c. Pathophysiology

1. Associated findings-severe abruptio placentae may produce

such complications as:a. renal failureb. disseminated intravascular

coagulation(DIC)c. maternal and fetal death

d. Assessment findings

2. Common clinical manifestations includea. intense, localized uterine pain, with or

without vaginal bleedingb. concealed or external dark red bleedingc. uterus firm to broadlike, with severe

continous paind. uterine contractionse. uterine outline possibly enlarged or

changing shapef. FHR present or absentg. fetal pressenting part may be engaged

3. Laboratory and diagnostic study findingsultrasound may be able to identify the

extent of abruption. However, the absence of a ultrasound finding does not rule out the presence of abruption.

1. Continually evaluate maternal and fetal physiologic status, particularly:

a. Vital signsb. Bleedingc. Electronic fetal and maternal monitoring

tracingsd. Signs of shock-rapid pulse, pallor, cold and

moist skin, decrease in blood pressuree. Decreasing urine outputf. Never perform a vaginal or rectal examination

or take any action that would stimulate uterine activity.

e. Nursing management

2. Assess the need for immediate delivery-if the client is in active labor and

bleeding cannot be stopped with bed rest, emergency cesarian birth may be indicated

3. Provide appropriate managementa. on admission, place the woman on

bed rest in a lateral position to prevent pressure on the vena cava

b. insert a large-gauge intravenous catheter into a large vein for fluid replacement. Obtain a blood sample for fibrinogen level

Thank you

*Joy