Abruptio Placentae

Presented by:
Pajaron, Edwin D.
Peterson, Mylene S.
Abruptio Placentae

– Premature separation of the placenta from the

uterine wall after the twentieth week of gestation
and before the fetus is delivered.
– The separation generally occurs late in pregnancy;
it may occur as late as during the first or second
stage of labor.
 Abruptio Placentae
– The primary cause of premature separation is unknown, but certain
predisposing factors have been identified, including:
a. high parity,
b. advanced maternal age,
c. a short umbilical cord,
d. chronic hypertensive disease,
e. pregnancy-induced hypertension,
f. direct trauma (as from an automobile accident or intimate partner
abuse),
g. vasoconstriction from cocaine or cigarette use
Abruptio Placentae
Assessment

– 1. Dark red vaginal bleeding. If the bleeding is high in the uterus or is minimal,
there can be an absence of visible blood.
– 2. Uterine pain or tenderness or both
– 3. Uterine rigidity
– 4. Severe abdominal pain
– 5. Signs of fetal distress
– 6. Signs of maternal shock if bleeding is excessive
Interventions
– 1. Monitor maternal vital signs and fetal heart rate.
– 2. Assess for excessive vaginal bleeding, abdominal pain, and an increase
in fundal height.
– 3. Maintain bed rest; administer oxygen, intravenous fluids, and blood
products as prescribed.
– 4. Place the client in Trendelenburg’s position if indicated to decrease the
pressure of the fetus on the placenta, or place in the lateral position with
the head of the bed flat if hypovolemic shock occurs.
– 5. Monitor and report any uterine activity.
Interventions

– 6. Prepare for delivery of the fetus as quickly as possible, with vaginal

delivery preferable if the fetus is healthy and stable and the presenting
part is in the pelvis; emergency cesarean delivery is performed if the
fetus is alive but shows signs of distress.
– 7. Monitor for signs of disseminated intravascular coagulation in the
postpartum period.
Difference between Placenta
Previa and Abruptio Placentae
– In placenta previa, there is painless, bright red vaginal bleeding, and
the uterus is soft, relaxed, and nontender. In abruptio placentae,
there is dark red vaginal bleeding, uterine pain or tenderness or
both, and uterine rigidity.
 Case Scenario
– The patient is a 40-year old woman with four prior normal vaginal
deliveries. She had no abnormal medical or family history. She smoked
20 cigarettes per day. She also denied the occurrence of any trauma. She
presented with sudden severe lower abdominal pain at 17 weeks
gestation, accompanied by severe vaginal bleeding. She was immediately
transferred from another hospital.
– Clinical findings: She was pale, blood pressure was 80/50 mmHg, and
pulse rate was 120 per minute. Heavy vaginal bleeding with blood clots
was confirmed. The uterus was contracting continuously, leading to
severe lower abdominal pain.
Continuation:

– Abdominal ultrasound: It showed a single live fetus with a normal heart rate.
Additionally, the placenta was attached to the anterior uterine wall, but a well-
defined 5×3 cm high-intensity region and a 1×2-cm low intensity region were
noted within the placenta suggestive of intra-placental hemorrhage
– A diagnosis of placental abruption at 17 weeks of gestation was made by clinical
symptoms and ultrasonographic finding. She was hospitalized to treat the DIC,
and hemorrhagic hypovolemic shock secondary to placental abruption.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective data: Deficient fluid volume: After 8 hours of shift, Independent: Goals met: After 8 hours
“Dinudugo ako” as Hypovolemia related the patient will be  Assess vital signs,  These changes of shift,the patient
verbalized by the patient. to increased able to: noting the blood in vital signs are verbalized understanding
vascularity of the pressure and pulse associated with of causative factors and
rate. fluid volume loss
Objective data: chorionic villi as  Verbalize purpose of individual
and/ or
 With vaginal bleeding evidenced by vaginal understanding of hypovolemia. therapeutic interventions
 With blood loss of bleeding, blood loss of causative factors and medication. The
700ml for 2 hours 220 ml and decreased and purpose of  To reduce patient also demonstrated
 With decreased RBC RBC count. individual  Change the position pressure on behaviors to monitor and
(3.18x1012/L) therapeutic frequently, turn side to fragile skin and correct deficit indicated.
side every 2 hours if tissues.
 Weak in appearance interventions and
necessary.
 With body malaise medication.
 Early
 BP: 80/50mmHg  Discuss factors related identification of
 PR: 120bpm  Demonstrate to occurrence of deficit risk factors can
behaviors to as individually decrease
monitor and appropriate. occurrence and
correct deficit, as severity of
complications
indicated.
associated with
hypovolemia.

 To note how
 Measure the amount of blood loss
blood loss. affects the
patient’s fluid
volume status.
Assessment Diagnosis Planning Intervention Rationale Evaluation
 Explain the drug which  To informed the
is ordered to the patient patient for the
and how it takes its possible
function. therapeutic
effects of the
drug.

 To prevent the
 Instruct the patient to recurrence of
maintain at bed rest. vaginal bleeding
associated with
frequent motion/
movements.

 To replace and
 Provide Intravenous conserve blood
(IV) fluids as ordered by volume contrary
the physician. to the blood loss
caused by
vaginal
bleeding.
Assessment Diagnosis Planning Intervention Rationale Evaluation
Subjective data: Acute Pain After 8 hours of  Monitor the amount of bleeding  TO measure the volume of After 8 hours of nursing
“Bigla nalang sumakit related to a nursing interventions, by weighing pads. blood loss interventions, the patient
ang tyan ko kahit hindi collection of the patient will  Assess pain by noting location,  Change in pain location or was able to demonstrate the
ko pa due date at blood between demonstrate use of duration, intensity, (0-10 scale) intensity are not uncommon, use of relaxation skills to
nagdudugo ako” as the uterine wall relaxation skills to and characteristics (dull, sharp, but may reflect increased promote comfort
verbalized by the and the placenta promote comfort constant). Monitor maternal V/S bleeding. Early recognition of
patient. and FHR rate pattern with increase bleeding allows for
continuous monitoring prompt intervention
Objective data:  Measure and record fundal
 With vaginal height  Fundal Height may increase
bleeding  Position mother in left lateral with concealed bleeding.
 With blood loss of position with the head of the  To enhance placental perfusion
700ml for 2 hours bed elevated
 With decreased  Provide back rubs, deep  Promotes relaxation
RBC (3.18x1012/L) breathing. Instruct in relaxation
 Weak in or visualization
appearance
 With body malaise
 Pain Scale 8/10
 BP: 80/50mmHg
 120 bpm