Abruptio Placenta Correct implantation Premature partial or complete separation of a normally implanted placenta It usually occurs after the

20th week gestation Most common cause of late pregnancy bleeding

Predisposing Factors Preeclampsia and hypertensive disorders Illicit drug use (especially cocaine) Accidents History of placental abruption High multiparity Increasing maternal age Cigarette smoking Short umbilical cord Presence of a uterine anomaly or tumor

Signs and Symptoms Dark red, painful vaginal bleeding Concealed hemorrhage (retroplacental) rigid board like abdomen Couvelaire uterus Severe abdominal pain Drop in coagulation factor

Types of Abruptio Placenta Partial abruption may occur at the center of the placenta Marginal abruption (detachment at the edge of the placenta) Complete abruption with concealed hemorrhage (whole detachment of the placenta)

Complications Disseminated intravascular coagulopathy (DIC) Maternal shock Amniotic fluid embolism (AFE) Postpartum hemorrhage Prematurity Maternal/Fetal Death Adult respiratory distress syndrome Renal tubular necroses Rapid labor and delivery Infection

Diagnostic Exam: Ultrasound examination of the placenta

Nursing Interventions Infuse fluids as ordered Blood typing and cross matching BT (blood transfusion) Monitor Fetal Heart rate Measure blood loss; count perineal pads Report signs and symptoms of DIC (disseminated intravascular coagulopathy) Monitor V/S Strict I/O

Medical management Emergency CS Vaginal Delivery if bleeding is heavy but controlled or pregnancy is greater than 36 weeks Conservative in hospital observation if both mother and fetus is stable bleeding is minimal and contractions are lessened

Manuel Carlo M. Escueta UASN 14 2A