I.

Introduction

Normally the placenta does not separate from the uterine wall until the baby is born. When the

placenta prematurely separates from the uterine wall severe hemorrhage can occur and threatens the life

of both the baby and mother. Placenta abruptio is the leading reason for hemorrhage related deaths in

pregnant women. The placenta is a round, flat organ that forms during pregnancy to give the baby food

and oxygen from the mother. Other causes of maternal death include cardiac disease, infection,

pulmonary embolism, and pregnancy-induced hypertension complications. Most cases of abnormal

bleeding during the second and third trimesters of pregnancy are caused by premature separation of the

placenta from the uterine wall and abnormal placental implantation.

This paper will review the tragic outcome of a case of placenta abruption; then will discuss the

concept diagram, incidence, causes, risk factors and medical management for bleeding caused by

placenta abruptio.

II. Assessment

A. Assessment tool – N/A

B. Laboratory and Diagnostic results

• Hgb- ↓ • BP - <90 mmHg

• PR- >100 bpm

• Platelet - ↓
• Vaginal bleeding

• Fibrinogen - ↓

III. Anatomy and Physiology

Recall that the placenta and umbilical cord connect the mother and the developing fetus. The placenta

and umbilical cord provides oxygen and nutrients to the baby and eliminates carbon dioxide and waste

products through a filtering system. A normal placenta is implanted high in the uterus and its surface

attaches to the uterus completely. It may be located on either the anterior or the posterior uterine wall.

(Fig.1)
 Fig. 1: The placenta normally implants high in the uterus.

Placenta abruptio happens when the placenta prematurely peels away from the normally implanted

uterus with associated bleeding occurring between the separated placenta and the uterine wall. The

amount of separation from the uterus in placenta abruptio ranges from partial to complete.

Either the blood may accumulate in the uterus, causing a concealed hemorrhage (Fig. 2) because it is

trapped between the placenta and uterine wall, or there may be an external hemorrhage (Fig 3.) when

blood drains through the cervix and out the body. In placenta abruptio, blood vessels rupture and create a

hematoma. This hematoma shears off the adjacent blood vessels, creating further bleeding and

separation of the placenta.

Fig. 2: Concealed hemorrhage (gray color) Fig.3: External hemorrhage (gray color)

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Classification of placental abruption is based on extent of separation (i.e., partial vs complete) and

location of separation (i.e., marginal Vs central).

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IV. Concept Diagram

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V. Medical Management

A. Ideal Management

1. Blood loss is minimized, and lost blood is replaced to prevent ischemic necrosis of distal

organs, including kidneys

2. DIC is prevented or successfully treated.

3. Normal reproductive functioning is retained

4. The fetus is safely delivered

5. The woman retains a positive sense of self-esteem and self-worth.

B. Actual Management

Prehospital Care

Provide emergency care at to all patients with suspected placental abruption. This care includes the

following:

• Continuous monitoring of vital signs

• Continuous high-flow supplemental oxygen

• One or 2 large-bore IV lines with normal saline (NS) or lactated Ringer (LR) solution

• Monitoring amount of vaginal bleeding

• Monitoring of fetal heart

• Treatment of hemorrhagic shock, if needed

Emergency Department Care

ED care depends on stage of gestation and severity of symptoms.

• Closely observe the patient.

• Administer supplemental oxygen.

• Continuous fetal monitoring.

• Administer IV fluids.

• Perform aggressive fluid resuscitation to maintain adequate perfusion, if needed.

• Monitor vital signs and urine output.

• Crossmatch 4 units of packed red blood cells. Transfuse, if necessary.

• Perform amniotomy to decrease intrauterine pressure, extravasation of blood into the

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 myometrium, and entry of thromboplastic substances into the circulation.

• Immediately deliver the fetus by cesarean delivery if the mother or fetus becomes unstable.

VIII. Prognosis (outlook)

Criteria Good Bad

Compliance to treatment Patient is compliant to the
medications.
Responsiveness to medication
Involvement of vital signs Maternal Hypovolemia
The mother does not usually die from this condition. However, the following increase the risk for

death in both the mother and baby:

• Absence of labor

• Closed cervix

• Delayed diagnosis and treatment of placenta abruption

• Excessive blood loss resulting in shock

• Hidden (concealed) vaginal bleeding in pregnancy

Fetal distress appears early in the condition in about half of all cases. The infants who live have a 40-50%

chance of complications, which range from mild to severe.

IX. Conclusion

Placenta abruptio is also called abruptio placenta or placental abruption. It affects about 9 out of

1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th

week of pregnancy. Placenta abruptio is a problem with the placenta during pregnancy. The placenta is a

round, flat organ that forms during pregnancy to give the baby food and oxygen from the mother. During a

normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until the baby has

been born. But with placenta abruptio, the placenta breaks away, or abrupts, from the wall of the uterus

too early, before the baby is born. This problem can cause, Premature birth., Low birth weight. ,Major

blood loss in the mother. Placenta abruptio can be very harmful for both the mother and the baby. In rare

cases, it can cause death.

With proper assessment, the group had come up with nursing diagnoses and prioritized nursing

interventions that would help monitor the condition of the mother and for the nurse and student nurses to

be aware on the things to be done during a placenta abruptio.

X. Recommendations

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 This case analysis recommend appropriate actions that will serve as a guide for the patient, the

patient’s family and significant others and the health care providers including the nurses and student

nurses.

For the patient, that she should participate with the nursing interventions to be implemented to

promote fast recovery from her condition. She should comply with the medications given.

For the patient's family members and other significant others, we encourage them to understand

the client's present condition. They should know their responsibilities in giving appropriate care to the

patient. They should be available emotionally, physically, to the patient’s needs for fast recovery of her

condition.

For the health care providers, including the nurses and student nurses, they should be equipped

with enough knowledge and skills in order to provide appropriate and effective nursing interventions for

the patient.

XII. Bibliography

Gaufberg, Slava V. E-Medicine Online: Abruptio Placentae from EmergencyMedicine/Obstetrics And

Gynecology. http://www.emedicine.com/emerg/topic12.htm#section~introduction. Mar 2001.

Kay HH (2003). Placenta previa and abruption. In JR Scott et al., eds., Danforth's Obstetrics and
Gynecology, 9th ed., pp. 365–379. Philadelphia: Lippincott Williams and Wilkins.

Hayes, Colleen M . MBA, RN, EMT-P. The Low Down on Placenta Abruptio.
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