Readings in

Abruptio Placenta

Submitted by:

Tumlos, Lizabell B

Group 10

Submitted to:

Mrs. Guada Dumapit, RN

Clinical Instructor

Abruptio Placentae or called placental abruption, is most common in multigravidas usually in

women older than age 35. Abruptio Placentae is the premature separation of a normally
implanted placenta before the delivery of the baby. It is characterized by a triad of symptoms:

 Vaginal bleeding
 Uterine hypertonus
 And fetal distress
It can occur during the prenatal or intrapartum period, a firm diagnosis when there's heavy
maternal vaginal bleeding generally necessitates termination of the pregnancy. The fetal distress
prognosis depends on the gestational age and amount of blood lost. The maternal prognosis is
good if hemorrhage can be controlled.

ssssss

Causes of Abruptio Placentae

definitive cause of Abruptio Placentae is unknown, but Predisposing factors;

 Vascular changes at the placental level

 Hypertension 
 Preterm premature rupture of membranes
 Smoking
 Cocaine abuse are the most common associated factors.
 A short umbilical cord
 Thrombophilias
 External trauma
 Fibroids (especially those located behind the placental implantation site),
 Severe diabetes or renal disease 
 Vena caval compression

Grading for Abruptio Placentae

1. Grade 0   Abruptio Placentae Less than 10% of the total placental surface has detached,
the patient has no symptoms however, a small etroplacental clot is noted at birth.
2. Grade I Abruptio Placentae Approximately 10%–20% of the total placental surface has
detached, vaginal bleeding and mild uterine tenderness are noted, however, the mother
and fetus are in no distress
3. Grade II Abruptio Placentae Approximately 20%–50% of the total placental surface
has detached, the patient has uterine tenderness and tetany, bleeding can be concealed or
is obvious, signs of fetal distress are noted, the mother is not in hypovolemic shock.
4. Grade III  Abruptio Placentae More than 50% of the placental surface has detached,
uterine tetany is severe, bleeding can be concealed or is obvious; the mother is in shock
and often experiencing coagulopathy, fetal death occurs.
Complications for Abruptio Placentae

 Hemorrhage and shock

 Renal failure
 Disseminated intravascular coagulation (DIC)
 Maternal and fetal death

Assessment Nursing Care Plans For Abruptio Placentae

Obtain an obstetric history.

 Date of the last menstrual period

 Estimated day of delivery
 Gestational age of the infant
 Alcohol, tobacco, and drug usage
 Trauma or abuse situations during pregnancy
 The onset of bleeding

Diagnostic tests Nursing Care Plans For Abruptio Placentae

Ultrasonography
Complete blood count (CBC), coagulation studies, type and crossmatch
Primary Nursing Diagnosis Nursing Care Plans For Abruptio Placentae
Fluid volume deficit related to blood loss
Other Nursing Diagnosis that may occur in Nursing Care Plans For Abruptio Placentae:

 Acute pain
 Anxiety
 Dysfunctional grieving
 Fear
 Ineffective coping
 Ineffective tissue perfusion: Cardiopulmonary

Nursing outcomes Nursing Care Plans For Abruptio Placentae

Fluid balance; Hydration; Circulation status, patient will:

 Express feelings of comfort.

 Express feelings of reduced anxiety.
 The patient's fluid volume will remain within normal parameters.
 Communicate feelings about the situation.
  Discuss fears and concerns.
 Use available support systems; e.g. Family and friends
 Hemodynamically remain stable.

Nursing interventions Nursing Care Plans For Abruptio Placentae

 Monitor Vital sign: blood pressure, pulse rate, respirations,

 Monitor central venous pressure, intake and output, and amount of vaginal bleeding.
 Monitor fetal heart rate.
 Provide emotional support during labor.
 Reassure the patient of her progress through labor, informed the patient of the fetus's
condition.
 Develop effective coping for patient and family

A. Schematic Diagram

Predisposing Factors Precipitating Factors

→ Age → Hypertension
 → Parity → Direct Trauma

→ Hypofibrinogenaemia

avulsion of the anchoring

placental villi from the

expanding lower uterine

Bleeding into the

decidua basalis

stretches and thins

the vessel wal

push the placenta away from the

uterus and cause further bleeding

Hard, boardlike

Abdomen

Painful vaginal bleeding Rigid abdomen Fetal bradycardia

MANAGEMENT: If not treated:

> It depends upon the condition of > complications may occur such as

the mother & fetus at the time the Hemorrhage, Prematurity, Infection, &

diagnosis is made. If the fetus if Fetal Death in the Utero

alive, prompt C-section is needed. If

there is Fetal Death in the Uterus,


Nursing Diagnosis: risk for fetal injury r/t impaired maternal – fetal nutrition and oxygen transfer to the fetus secondary to premature placental separation.
Subjective:
Patient reports abdominal
discomfort (maternal).
Objective:
Weak fetal heart rate and
tone
Decrease fetal movement
Little/no vaginal bleeding
(maternal)
Nursing Care Plan (NCP)
STO: Educate mother to have a complete bed rest. Bed rest helps prevent further complications
and helps limit oxygen consumption.
Within 20-40 minutes of
administering IV fluids
and oxygen supplement
to the mother, the fetus Alterations of the vital signs of the mother
will be able to receive Assess and monitor continuously the vital signs of and fetus from the normal values may
adequate amount of the mother and the fetus. indicate that there is something wrong in the
oxygen and nutrients for body of the mother.
life support.
To assess respiratory insufficiency.
LTO:
Within 1-4hrs of letting Evaluate pulse oximetry of the mother to
the mother have determine oxygen saturation in her body.
complete bed rest,
providing safety This provides adequate supply of oxygen to
measures and promoting the blood of the mother while circulating,
a clean and quiet Provide/administer supplemental oxygen thus nutrients and oxygen will be transported
environment, the fetus saturation at lowest concentration or as indicated to the fetus.
will be able to receive by the laboratory results.
continuous amount of
oxygen necessary for
the transportation of For nutritional support to the mother and
nutrients.sssssssS Administer IV fluids, as indicated. fetus and for fluid replacement, if vaginal
bleeding occurs.
To protect client from injuries and to provide
the patient comfort
Provide safety measures (e.g. raise side rails and
keeping off things that are sharp and edgy), and
promoting a clean and quiet environment. To help in the circulation, and avoid
compressing the vena cava
to continuously assess FHR
 Position mother in left lateral position
Begin electronic fetal monitoring
Have equipment for emergency cesarean delivery
readily available
Prepare the patient and family members for the
possibility of an emergency CS delivery, the
delivery of a premature neonate and the changes
to expect in the postpartum period
offer emotional support and an honest
assessment of the situation
tactfully discuss the possibility of neonatal death
encourage the patient and her family to verbalize
their feelings
Help them to develop effective coping strategies,
referring them for counseling if necessary
Nursing Care Plan (NCP)Nursing Diagnosis: Fluid Volume Deficit r/t massive vaginal hemorrhage due to secondary to complete placental separation
The delivery method of choice is CS
To help the SOs understand the critical
condition of the mother and have
reassurances of the mother’s current
condition
To help the SOs and mother to prepare
physically and emotionally to the situation
Tell the mother that the neonate’s survival
depends primarily on gestational age, the
amount of blood lost, and associated
hypertensive disorders-assure her that
frequent monitoring and prompt
management greatly reduce the risk of
death.
Allowing them to understand clearly the
situation
Helps the SOs and mother cope with the
situation properly.
Subjective: STO: Continuous evaluate maternal and fetal Alteration in vital signs can call for prompt
physiologic status, particularly: actions.

The patient may report: After 30-60 minutes of
administering oxygen
Thirst supplement and
performing blood
Weakness transfusion, the patient’s
blood components that
Dizziness were lost will be replaced
and the patient’s
circulation of blood and
oxygen delivery/transport
to the tissues will be
stabilized.
 Vital Signs
 Bleeding If the client is in active labor and bleeding
 Electronic fetal and maternal monitoring cannot be stopped with bed rest, emergency
tracings cesarean delivery may be indicated
 Signs of shock – rapid pulse, cold and
moist skin, decrease in blood pressure
 Decreasing urine output
 Never perform a vaginal or rectal To prevent pressure on the vena cava.
examination or take any action that
would stimulate uterine activity.
for fluid replacement.

Asses the need for immediate delivery..

To find out the extent of hemorrhage for prompt
On admission, place the woman on bed rest in intervention.
a lateral position
LTO:

Allows prompt intervention if fetal distress is

Insert a large gauge intravenous catheter into detected.
After 1-2 hrs of continuing a large vein for fluid replacement.
oxygen supplementation,
administering blood
transfusion, and providing
a calm and stimulant free
Objective: the method of choice for the birth
environment such as
limiting the visitation Obtain a blood sample for fibrinogen level.
hours, the patient will be
able show improvements Monitor the FHR externally and measure
Decreased urine output; maternal vital signs every 5 to 15 minutes. Allows them to understand the situation
such as moist skin, moist
increased urine
mucus membrane,
concentration
normal skin turgor (<1-2
sec), pinkish skin, and
Decreased venous filling; Prepare for cesarean section Calms client and helps her to take in the stress.
normal blood pressure
decreased pulse
within the range of
volume/pressure
100/80mmHG-
130/90mmHg. To evaluate effectiveness of resuscitation
Sudden weight loss (except
in third spacing) measures
Decreased BP; increased
pulse rate/body temperature
Decreased skin/tongue
turgor; dry skin/mucous
membranes
Change in mental state
Elevated hematocrit
Decreased blood pressure
(<120/80)
Dry skin
Dry mucous membrane
Decreased skin turgor (>1-2
seconds)
Increased pulse rate
Increased blood clotting
factors
increased body temperature
(>36.7- 37.5*C)
confusion
Pallor
Provide client and family teaching. to maintain skin integrity and prevent excessive
dryness
caused by dehydration
Address emotional and psychosocial needs.
Alterations in the vital signs may indicate that
there is something wrong in the body systems.
Maintain accurate I/O and weigh daily.
Measure urine specific gravity. Monitor blood
Prevents peaks in fluid level.
pressure and invasive hemodynamic
parameters as indicated (e.g., CVP,
PAP/PCWP)
To replace the fluid lost in the body.
Change position frequently. Bathe
infrequently, using mild cleanser/soap, and
provide
optimal skin care with emollients
Humidity and air temperature affects any
Assess and monitor vital signs; BP,PR,RR, changes in the body temperature of the client.
temp
Provide fluid replacement needs and routes to
be used. To prevent tissue injury from dryness.
Administer IV fluids. Administer blood Protects the patient from any physical injuries.
products/ plasma expanders as indicated.
These promote comfort to the patient.
Control humidity and ambient air temperature
and perform TSB when there is fever.
Provide and perform oral care and eye care, Fever further causes dryness and dehydration.
and skin care.

Provide safety measures such as raising the
side rails and keeping sharp things away from
the patient, that is, when the client is
confused.
Decrease in blood due to hemorrhage means
the decrease in oxygen supply in the body.
Administering oxygen via mask provides more
oxygen faster.

Provide and maintain a clean and well To prevent further complications to the mother
ventilated room, and provide and maintain a and to prevent fetal demise/ death.
calm and quiet environment.

Administer antipyretics to reduce fever as

ordered by the physician.

Administer oxygen supplement via mask.

Stop blood loss: administer anticoagulant

drugs as ordered, and prepare for surgical
intervention or immediate delivery as needed.