Abruptio Placenta

Description • Abruptio placenta is premature separation of a normally implanted placenta after the 20th week of pregnancy, typically with severe hemorrhage.

Etiology 1. The cause of abruptio placenta is unknown. 2. Risk factors include: • • • • • • • • • Uterine anomalies Multiparity Preeclampsia Previous cesarean delivery Renal or vascular disease Trauma to the abdomen Previous third trimester bleeding Abnormally large placenta Short umbilical cord

Pathophysiology • The placenta detaches in whole or in par from the implantation site. This occurs in the area of the deciduas basalis.

Assessment Findings 1. Associated findings. Severe abruption placentae may produce such complications as: a. Renal failure b. Disseminated intravascular coagulation c. Maternal and fetal death

Laboratory and diagnostic study findings. localized uterine pain. the absence of an ultrasound finding does not rule out the presence of abruption. amount of fetal hypoxia. Uterine contractions e. Intense. Obtain a blood sample for fibrinogen level. with severe continuous pain d. b. 4. Uterus firm to boardlike. Outcome for the mother and fetus depends on the extent of the separation. g. which is the method of choice for the birth. 3. 5. Nursing Management 1. Insert a large gauge intravenous catheter into a large vein for fluid replacement. Concealed or external dark red bleeding c.2. However. pallor. and amount of bleeding. • • • • On admission. Fetal presenting part may be engaged. • Ultrasound may be able to identify the extent of abruption. particularly: • • • • • • Vital signs Bleeding Electronic fetal and maternal monitoring tracings Signs of shock-rapid pulse. . Address emotional and psychosocial needs. Provide client and family teaching. decrease in blood pressure Decreasing urine output Never perform a vaginal or rectal examination or take any action that would stimulate uterine activity. Common clinical manifestation include: a. Provide appropriate management. Monitor the FHR externally and measure maternal vital signs every 5 to 15 minutes. emergency cesarean delivery may be indicated. with or without vaginal bleeding. cold and most skin. Continuously evaluate maternal and fetal physiologic status. Uterine outline possibly enlarged or changing shape f. FHR present or absent. 3. If the client is in active labor and bleeding cannot be stopped with bed rest. Administer oxygen to the mother by mask. Assess the need for immediate delivery. Prepare for cesarean section. 2. place the woman on bed rest in a lateral position to prevent pressure on the vena cava.

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