Abruptio Placenta

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Abruptio Placentae

City Health Office, Roxas City December 12-14, 2013

Submitted by: Solidum, Juan Carlo Z. BSN 4 Non-Maleficence

Submitted to: Mrs. Guada Dumapit, RN, MAN Clinical Instructor

Abruptio Placentae Premature separation of normally implanted placenta, may be marginal (near edge) with dark red vaginal bleeding or central (at center) with concealed bleeding. Clinical Manifestations: 1. Painful dark red vaginal bleeding 2. Uterine rigidity and tenderness 3. Rapid signs and symptoms of maternal shock and/ or fetal distress 4. Back pain 5. Abdominal pain Causes: - Unknown but possible causes include trauma or injury to the abdomen from an auto accident or fall, for example or rapid loss of the fluid that surrounds and cushions the baby in the uterus. Risk Factors: Previous placental abruption. If you've experienced placental abruption before, you're at higher risk of experiencing it again. High blood pressure. High blood pressure whether chronic or as a result of pregnancy increases the risk of placental abruption. Abdominal trauma. Trauma to your abdomen such as from a fall or other type of blow to the abdomen makes placental abruption more likely. Substance abuse. Placental abruption is more common in women who smoke or use cocaine during pregnancy. Premature rupture of the membranes. During pregnancy, the baby is surrounded and cushioned by a fluid-filled membrane called the amniotic sac. The risk of placental abruption increases if the sac leaks or breaks before labor begins. Blood-clotting disorders. Any condition that impairs your blood's ability to clot increases the risk of placental abruption. Multiple pregnancy. If you're carrying more than one baby, the delivery of the first baby can cause changes in the uterus that trigger placental abruption before the other baby or babies are delivered. Maternal age. Placental abruption is more common in older women, especially after age 40. Incidence: It occurs in about 10% of pregnancies and is the most common cause of perinatal death. Medical Management: 1. Blood tests 2. Ultrasound 3. Immediate delivery usually Cesarean Section Nursing Management: 1. Continuous evaluate maternal and fetal physiologic status, particularly: Vital Signs

2. 3.

4. 5.

Bleeding Electronic fetal and maternal monitoring tracings Signs of shock rapid pulse, cold and moist skin, decrease in blood pressure Decreasing urine output Never perform a vaginal or rectal examination or take any action that would stimulate uterine activity. Asses 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. 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 Provide client and family teaching. 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.

Summary Placental abruption in pregnancy means the placenta has detached from the wall of the uterus, either partly or totally. This can cause heavy bleeding in the mother and can starve the unborn baby of oxygen and nutrients. The condition is also known as placental abruptio or abruptio placenta. Symptoms include bleeding, abdominal pain and frequent uterine contractions.

Reference: Online: http://www.uptodate.com/contents/placental-abruption-clinical-features-anddiagnosis

SCHEMATIC DIAGRAM

Rupture of maternal vessels In the decidua basalis

Bleeding from the fetal-placental vessels

Accumulating blood splits the decidua

Bleeding may be small and selflimited

Leading to complete or near complete placental separation

Detached portion of the placenta is unable to exchange gases and nutrients

Fetus becomes compromised

CONCEPT MAP

Predisposing Factors Maternal Age (40) ABRUPTIO PLACENTAE

Precipitating Factors Previous placental abruption High blood pressure Abdominal trauma Substance abuse Premature rupture of the membranes Blood-clotting disorders Multiple pregnancy

Clinical Manifestations Unknown cause 1. Painful dark red vaginal bleeding 2. Uterine rigidity and tenderness 3. Rapid signs and symptoms of maternal shock and/ or fetal distress 4. Back pain 5. Abdominal pain

Medical Management 1. Blood tests 2. Ultrasound 3. Immediate delivery usually Cesarean Section

1. Continuous evaluate maternal and fetal physiologic status. 2. Asses 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. 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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