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Abruptio Placenta

Abruptio Placenta

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Published by miss RN

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Published by: miss RN on Feb 08, 2009
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03/05/2013

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ABRUPTIO PLACENTA
 Definition:
-Premature separation of the placenta from the uterine wall.-Common cause of bleeding during the second half of pregnancy-Usually occurs after 20 to 24 weeks of pregnancy but may occur as late as duringfirst or second stage of labor.Risk factors:-women with parity of 5 or more-women over 30 years of age-women with pre-eclampsia - eclampsia and renal or vascular disease.Factors contributing to ABRUPTIO PLACENTA-multiple gestations-hydramnios-cocaine use-dec. blood flow to the placenta-trauma to the abdomen-dec. serum folic acid levels-PIHCause: UnknownTheories proposed relating it’s occurrence to dec. blood flow to the placentathrough the sinuses during the last trimester; Excessive intrauterine pressure caused byhydramnios or multiple pregnancy may also be contributing factors.
Clinical manifestations:
Covert (severe)/ Mild separation/ Mild Abruptio PlacentaThe placenta separates centrally and the blood is trapped between the placenta andthe uterine wall.Signs and Symptoms:1.no overt bleeding from vagina2.rigid abdomen3.acute abdominal pain4.dec. BP5.inc. pulse6.uteroplacental insufficiencyOvert (partial)/ Moderate separation/ Moderate Abruptio PlacentaThe blood passes between the fetal membranes and the uterine wall and escapesvaginally. May develop abruptly or progress from mild to extensive separation withexternal hemorrhage.Signs and Symptoms:1.vaginal bleeding2.rigid abdomen
 
3.acute abdominal pain4.dec. BP5.inc. pulse6.uteroplacental insufficiency Placental Prolapse/ Severe separation/ Severe Abruptio PlacentaMassive vaginal bleeding is seen in the presence of almost total separation with possible fetal cardiac distress.Signs and Symptoms:1.massive vaginal bleeding2.rigid abdomen3.acute abdominal pain4.shoc5.marked uteroplacental insufficiency
 Management:
-monitoring of maternal vital signs, fetal heart rate (FHR), uterine contractions andvaginal bleeding-likelihood of vaginal delivery depends on the degree and timing of separation inlabor -cesarean delivery indicated for moderate to severe placental separation-evaluation of maternal laboratory values-F & E replacement therapy; blood transfusion-Emotional support
 Nursing Interventions
:-Assess the patient’s extent of bleeding and monitor fundal height q 30 mins.-Draw line at the level of the fundus and check it every 30 mins (if the level of thefundus increases, suspect abruptio placentae)-Count the number of pads that the patient uses, weighing them as necessary todetermine the amount of blood loss-Monitor maternal blood pressure, pulse rate, respirations, central venous pressure,intake and output and amount of vaginal bleeding q 10 – 15 mins-Begin electronic fetal monitoring to continuously assess FHR -Have equipment for emergency cesarean delivery readily available:-prepare the patient and family members for the possibility of anemergency CS delivery, the delivery of a premature neonate and thechanges to expect in the postpartum period-offer emotional support and an honest assessment of the situation-if vaginal delivery is elected, provide emotional support during labor -because of the neonate’s prematurity , the mother may not receive ananalgesic during labor and may experience intense pain-reassure the patient of her progress through labor and keep her informedof the fetus’ condition-tactfully discuss the possibility of neonatal death
 
-tell the mother that the neonate’s survival depends primarily ongestational age, the amount of blood lost, and associated hypertensivedisorders-assure her that frequent monitoring and prompt management greatlyreduce the risk of death.-encourage the patient and her family to verbalize their feelings-help them to develop effective coping strategies, referring them for counseling inecessary.
Goals of Care:
1.blood loss is minimized, and lost blood is replaced to prevent ischemic necrosis of distal organs, including kidneys2.DIC is prevented or successfully treated.3.normal reproductive functioning is retained4.the fetus is safely delivered5.the woman retains a positive sense of self-esteem and self-worth.
 Additional lab results:
Hgb-
Platelet -
Fibrinogen -
Fibrin degradation products -
Other possible nursing diagnosis:
Impaired gas exchange: fetal related to insufficient oxygen supply secondary to premature separation of the placenta.
Pain related to bleeding between the uterine wall and the placenta secondary to premature separation of the placenta.
Fear related to perceived or actual grave threat to body integrity secondary toexcessive bleeding and threat to fetal survival.
Grieving related to actual or threatened loss of infant.
Powerlessness related to maternal condition and hospitalization.
Risk for deficient fluid volume related to excessive losses secondary to premature placental separation.

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