I.

Introduction

Abruptio placenta is a condition that occurs during the 3 rd trimester of pregnancy. It is where the placenta
immaturely separates from the uterus after 20 weeks of gestation. The signs and symptoms of abruption placenta
are: sharp stabbing pain, rigid board-like abdomen (Couvelar’s sign), and dark red blood. The causes of placenta
abruption are normally trauma or injury to the abdomen. Rapid loss of fluid that surround and cushions the fetus in
the uterus (amniotic fluid) can also increase the risks for abruptio placenta. Smoking also contributes to the
possibility of developing placental abruption as the chemicals (nicotine or tobacco) causes vasoconstriction to the
uterine and umbilical arteries which aids in the premature separation of the placenta. There are three types of
abruption placenta, total abruption, central/concealed abruption, and marginal abruption. Total abruption is where
the placenta completely covers the cervix. Marginal placenta abruption is where the placenta is near the edge of the
cervix. While the central/concealed abruption placenta is where the placenta remains bleeding within the uterus and
forms a clot retroplacentally. With this type, bleeding may not be visible, but may become severe and could lead to
systemic shock.

II. Objectives

General:

 To understand the nature of abruption placenta

 To attain knowledge of the risk factors that causes this condition
 To formulate nursing care plans on how to manage and support women who develops abruption placenta

III. Nursing Health History

 Biographic data:
o Name: E.Q.
o AGE: 40 year’s old
o Gender: female
o Source of information: the patient
o Admitting impression or final diagnosis (if admitted in the hospital: Abruptio Placenta
 Chief complaint:
o Moderate blooding, with mild to moderate uterine contractions
 History of present illness:
o Three weeks before, mild uterine contraction
 Obstetric history:
o LMP: 10/07/20
o G:1
o T:1
o P:0
o A:
o L:1
o EDC: 07/14/20
 Past medical history:
o Sought consultation three weeks ago due to mild uterine contractions with vaginal bleeding
o An hour before admission, patient was experiencing mild to moderate vaginal bleeding with
moderate uterine contractions
 Family health history:
o Mother:
 Hypertensive
 Diabetic
o Father: N/A
 Lifestyle:
 o Drinks caffeinated beverages
o Excessively eats junkfoods, and noodles for breakfast, as well as snacks in her workplace
o Smokes starting the age of 20 around 6-7 sticks per day
IV. Physical Examination
 Vital signs:
 BP: 120/80 mmHg
 Temp: 37 degrees Celsiua
 PR: 88 bpm
 RR: 16 cpm
 Integumentary system: inspection of the client’s skin was found pale, and poor skin turgor was
observed
V. Symptoms Manifested
 Moderate bleeding
 Mild to moderate uterine contractions
 Vaginal spotting

Other possible signs and symptoms of abruptio placenta:

 Abdominal pain
 Back pain
 Uterine tenderness or rigidity
 Dark red vaginal bleeding
VI. Pathophysiology

Anatomy of the fetal circulation:

The oxygenated blood then flows

Oxygen, nutrients and Then the blood
through the umbilical veinflows
to go
minerals from the mother’s
to the fetus’ liver and passes vena
through the inferior
blood flows to the placenta cava tocalled
the right atrium.
through a shunt ductus
via the umbilical cord.
venosus.

Following this, the

Unoxygenated blood and waste
products of the fetus is then
delivered back to the heart, to
the right atrium first, then left
atrium.
Then the blood is delivered to
oxygenated blood passes
the fetus’ brain via the aorta and
through the foramen ovale
to the rest of the extremeties.
to the left atrium then to
the left ventricle.
Unoxygenated blood and the waste
products goes out by going back to the
placenta through the ductus arteriosus
using the umbilical artery to be exchanged
for oxygen-rich blood with minerals and
nutrients.

Pathophysiology of abruptio placenta

 Predisposing factors:
Precipitating factors:
 Family medical history of
hypertension and diabetic  Unhealthy habits (smoking)
 Short umbilical cors  Imbalance meals (junkfoods,
noodles, snacks)
 Possible trauma from factory
workplace

Destruction of endometrium linings of the

uterus (decidua basalis).

Formation of hematoma which

produces bleeding from the Abdomen becomes Blood goes through
vagina hard and rigid the amniotic sac

Detached placenta cannot function

and could lead to rapid fetal Blood accumulates and separates
compromise the placental attachment from the
basal layer.

VII. Diagnostic and Laboratory

E.Q.’s results Normal values Significance

Hemoglobin 7.9 g/dL 12-16 g/dL E.Q.’s results are below
the normal range. This
may be because a mild
anemia is developing.
The cause of this is from
low levels of iron and
vitamins. This may cause
the patient feeling weak
and tired.
Hematocrit 29% 36-48% Patient’s haematocrit
levels are also below
average. This may
indicate anemia,
myeloproliferative
disorders, COPD, or other
hypoxic lung conditions.
Platelet count 82,000/L 250,000/L Platelet count is very low.
This may be an indication
for gestational
thrombocytopenia.
Prothrombin time 11.2 seconds 11-13.5 seconds Patient’s results are
within the normal range.
Which means that the
time for the patient’s
 blood to clot is efficient.

VIII. Medical and Surgical Management

1. Intravenous therapy: larger gauge catheter to help replace fluid loss and prevent hypovolemic shock
2. Oxygen inhalation: can help E.Q. to breathe properly, deliver oxygen to the fetus efficiently and prevent fetal
anoxia
3. Fibrinogen determination: helps detect DIC (disseminated intravascular coagulation) a condition where
blood clots form blocking small blood vessels
4. Caesarean delivery: the safest way to deliver the baby
5. Hysterectomy: only if the patient develops DIC, to avoid exsanguinations (severe blood loss)

IX. Drug Study

Drug Name Classification Indication and Side Effects and Special Nursing
and contraindications Adverse Effects Precautions responsibilities
Mechanism of
Action
Generic Name: Classifications: Indications:  Headache Drug should MIO with patients
Ketorolac Non-steroidal For pain and  Nausea be adjusted with a history of
Tromethamine anti- inflammation after  Diarrhea for patients cardiac
inflammatory surgery  Dizziness 65 years old decompensation,
Brand Name: drug  Pruritus and older, renal impairment,
Toradol Contraindications:  Edema patients heart failure, or
Actions:  Cardiovascula  Drowsiness under 50 kg liver dysfunction
Dosage: 30 mg Treats r thrombotic  Hypertension of body
moderately events, MI, weight, and Monitor for signs
Route: IV severe pain and and stroke patients of GI distress or
inflammation  GI issues with bleeding, nausea,
Frequency and after surgery. It  For moderately GI pain, diarrhea,
timing: Every 6 blocks the prophylactic elevated melena, or
hours for 3 days production of analgesic serum hematemesis
prostaglandins  Renal creatinine
which causes problems Ask patient to not
pain, fever, and drive
inflammation
Generic Name: Classifications: Indications:  Diarrhea Caution the Assess patients
Mefenamic acid A fenamate Mild to moderate pain,  Constipation patient to who develop
groups of including menstrual  Gas or call their severe diarrhea
Trade/Brand NSAIDs pain, fever, and bloating doctor if and vomiting risk
Name: Ponstel inflammation  Headache experiencin for dehydration
Actions:  Dizziness g chest pain and electrolyte
Dosage: 500 mg Exhibits anti- Contraindications:  Nervousness or imbalance
inflammatory, Patients with salicylate  Ringing in the discomfort,
Route: Orally analgesic, hypersensitivity or ears nausea and Perform lab tests
antipyretic NSAID hypersensitivity, vomiting, for normal results
Frequency and activities. asthma, urticarial, or pain in
timing: 1 tablet Inhibits other allergic reactions arms, jaw, Notify doctor if
every 6 hours prostaglandin to aspirin or NSAIDs back, or persistent GI
synthetase. neck, discomfort, sore
shortness of throat, fever, or
breath, malaise
slurring of
speech or Do not drive
weakness.
Monitor blood
glucose levels for
loss of glycemic
control if diabetic
Generic Name: Classifications: Indications:  Rash History of Culture infection,
Cefuroxime Cephalosporin Tonsillitis, acute  Fever hypersensit- and arrange for
antibiotics bacterial maxillary  Pruritus ivitiy to sensitivity tests
Dosage: 500 mg sinusitis, bronchitis,  Erythema penicillin, before and during
Actions: uncomplicated  GI bleeding and GI therapy
Route: Orally Inhibits pneumonia, skin and infection disease
bacterial cell structure infections,  Abdominal (colitis), Taken with food
Frequency and wall synthesis uncomplicated UTI, pain renal to decrease GI
timing: Every 8 by binding to gonorrhoea  Flatulence impairment upset and
hours one or more  Indigestion enhance
penicillin- Contraindications:  Thirst absorption
binding Hypersensitivity to  Dyspepsia
proteins to cefuroxime or other  Sleepiness Have vitamin K
inhibit the cephalosporins  Thrombocyto available in case
synthesis of penia of
bacterial cell hypoprothrombin
walls which emia occurs
leads to
bacterial cell Discontinue if
death hypersensitivity
reaction occurs
Generic Name: Classifications: Indications:  Nausea Caution in May be taken
Hemarate Over-the- Iron deficiency anemia,  Vomiting those with after food to
counter folate deficiency, and  Bloating and chronic liver reduce GI side
Dosage: 500 mg supplement lowering of plasma upper failure, effects
homocysteine abdominal alcoholic
Route: Orally Actions: discomfort cirrhosis, May experience
Iron, vitamin B Contraindications:  Diarrhea or chronic discoloured stools
Frequency and and folic acid Allergic to any constipation alcoholism,
timing: Once a prevents and ingredient of the drug. and
day treats iron- Iron supplement pancreatic
deficiency avoided in condition insufficiency
anemia and associated with iron
vitamin b- overload
complex
deficiencies to
produce
healthy blood
and synthesis
of hemoglobin
Generic Name: Classifications: Indications:  Nausea Not given Monitor
Isoxsuprine Are For pre-term labor or  Vomiting during therapeutic
vasodilators peripheral vascular  Nervousness preterm effectiveness
Trade/Brand diseases  Weakness labor if
Name: Duvadilan Actions:  Rash there is an Monitor BP and
Increases the Contraindications:  Breathlessnes infection. pulse, can cause
Dosage: 10 mg flow of blood in To patients who are s hypotension and
blood vessels allergic to isoxsuprine,  Tightness in tachycardia
Route: Orally and uterine have hypotension or the chest
relaxant an artery that bleeds,  Chest pain Observe both
Frequency and rapid heartbeat or any  Irregular mother and baby
timing: Every 6 condition that leads to heartbeats for any
hours bleeding  Flushing irregularities in
 Severe vital signs
dizziness
 Decreased
calcium

X. Nursing Care Plan

Assessment Diagnosis Objective/Planning Intervention Rationale Evaluation

Subjective: Risk for infection Short-term goal: Educate the client This will make her After
Moderate related to post- Provide nursing on the different aware on what to implementing all
bleeding, with operative incision interventions to signs and look out for in of the necessary
mild to moderate the client on symptoms of case an infection nursing
uterine techniques how to infection (fever, may develop. interventions, the
contractions prevent infection chills, redness, client will be
on her incision site swelling, stocked with
Objective: within 3 hours. drainage). techniques and
37.4 degrees knowledge about
Celsius Long-term goal: Instruct the This will prepare sterile wound
89 bpm The client will be patient on how to the client on how care. There will be
17 cpm equipped of the wash her incision to clean her no signs or
160/80 mmHg proper knowledge site, which soaps incision site symptoms of
on how to care for are safe to use, properly. Good infection growing.
her post-operative and must rinse hygiene will The client will feel
incision after 9 with luke-warm prevent her from confident, and
hours of nursing water. developing assured on how to
interventions. bacterial growth care for her
Teach the client Wet, and moist incision site and
the importance of areas are the promote a fast
keeping her breeding grounds recovery rate.
wound dry at all of infection.
times. Educating the
client to keep her
incision dry will
lower the chances
of infections to
grow.

Suggest the client This will allow her

to lessen her wound to heal,
physical and prevent it
movements to at from rupturing.
least 2-3 weeks.

Ensure that the To help reduce

client understands the risk of
the vitality of infection.
sterile dressing
techniques.

Teach the client to Decreases the

take her chances of
antibiotics as bacteria to
scheduled by the develop on the
doctor. incision site.

XI. Discharge Plan and Health Teachings

 Diet:
o Eat healthy balanced meals
o Avoid junkfoods, and noodles for breakfast
o Lessen the snacks in the workplace
o If breastfeeding, increase calorie in-take
o Drink a lot of fluid to avoid constipation
o Eat meals rich in fiber, such as, whole grains, cereal, bread fruits, vegetables, beans and lentils
o A glass of warm water and teas (chamomile or fennel tea) every morning instead of coffee to
hydrate the body and provide electrolytes
 Medications:
o Take prescribed medications at specific timings, amount, and route as said by the doctor
o Do not change or miss any medications
 If so, contact the doctor
 Incision care:
o Take a shower as needed and ensure that incision is patted completely dry
o Client can wash the incision area with mild soap and water
o Do not soak in a bathtub or go swimming until the doctor said otherwise
o Educate for signs of infection like redness and drainage
o Place a pillow on the incision area when laughing, coughing, or moving to lower discomfort
 Lifestyle:
o Advice the patient to stop smoking as this contributes to the incident of developing the condition
again
o Avoid unhealthy eating habits
o Exercise regularly after 6 weeks’ rest and only if the incision area has completely healed
o Halt any sexual activities
o Take some time to relax everyday, do deep breathing exercises and meditations
 When to call the doctor:
o Signs of infection (fever and chills)
o Heavy vaginal bleeding
o Foul-smelling vaginal discharge
o Bleeding, redness, swelling, and increasing pain from incision site
o Fainting
o Swelling or pain in one or both legs
o Pain or urgency with urination
o No bowel movement after 1 week of birth
o Feeling anxious, panic, or depressed
 Follow-up check-ups are after 2 weeks of delivery for women who underwent C-section