Iloilo Doctors’ College

College of Nursing

Care of Mother & Child At Risk or with Problems (Acute & Chronic)
NCM 109 RLE

Case Scenario #3: Abruptio Placenta

A case of patient E.Q. 40 year old married a factory worker. She is 36 weeks pregnant with her
first baby. Came to the hospital at around 3:20 a.m. with a chief complaint of moderate
bleeding, with mild to moderate uterine contractions. Three weeks prior to admission, the
patient manifested mild uterine contraction with vaginal spotting. She sought consultation and
was given Duvadilan 10 mg every 6 hours and was advised bed rest without bathroom
privileges. An hour prior to admission a patient experienced mild to moderate vaginal bleeding
with moderate uterine contraction. The physical assessment shows that patient is pale, has
poor skin turgor Temp. 37°C; PR: 88 bpm; RR: 16cpm and BP 120/80 mmHg, LMP:
05/21/2021, EDC: 02/28/2022. Abdominal Ultrasound was requested and revealed a live fetus,
the placenta was attached to the anterior uterine wall, but with a suggestive separation and
rounding of the placental edge. Upon auscultation, the heartbeat of the baby is 100 beats/min.
The doctor suggested a Stat cesarean section, her husband was appraised of her status. A
diagnosis of Abruptio Placenta based on clinical symptoms and ultrasonographic findings.

She used to drink caffeine beverages and have fun eating junk foods, noodles for breakfast and
snacks in her workplace. She is a known smoker at the age of 20 and consumed 6-7 sticks a
day and stopped when she got pregnant. Her mother is a known hypertensive and diabetic.

The patient’s OB score is G1T1P0A0L1. She has regular prenatal check-ups in the Lying-in
Clinic.

Laboratory findings: Hemoglobin 7.9 g/dl, Hct 29%, Platelet count 82,000/L, Prothrombin time
11.2 seconds, Na 146.5, K 3.85, Chloride 107.5, RBC 5.6 million/mm3, Urinalysis positive RBC.

Venoclysis started 0.9% NaCl to run for 15gtts/minute; transfuse 2 units of PRBC after
crossmatch. Insert indwelling catheter attached to the urinary bag as ordered. At 4:30 am
patient E.Q. was wheeled into the Operating Room for Caesarean Section. At exactly 5 o’clock
in the morning she delivered a live baby boy weighing 2400g via Low Segment Transverse
Caesarean Section (LSTCS), Post-op orders: Ketorolac Tromethamine 30mg IVTT every 6 hours
for 3 days then shift to oral Mefenamic acid 500mg 1tablet every 6 hours PRN for pain;
Cefuroxime 500mg every 8 hours; Hemarate 500mg 1 tablet once a day; monitor vital signs
every 15 minutes until stable and watch out for any untoward signs and symptoms. Her latest
vital sign is T-37.4°C; PR- 89bpm; RR- 17cycle/minute; BP 160/90mmHg. She was about to
transfer into the room when fully awake and stable.
QUESTIONS:

1. What is Abruptio Placenta?

- A complication of late pregnancy or labor characterized by premature partial or

complete separation of a normally implanted placenta also termed accidental
hemorrhage and ablation placenta.

2. What are the different types of Placental Abruption? Describe each type.

- subchorionic abruption - bleeding between myometrium and placental membranes.

- retroplacental abruption - bleeding between myometrium and placenta.
- preplacental abruption - bleeding between placenta and amniotic fluid.
- intraplacental abruption.

3. What are the risk factors for Placental Abruption?

Factors that can increase the risk of placental abruption include:

 Placental abruption in a previous pregnancy that wasn't caused by abdominal

trauma
 Chronic high blood pressure (hypertension)
 Hypertension-related problems during pregnancy, including preeclampsia, HELLP
syndrome or eclampsia
 A fall or other type of blow to the abdomen
 Smoking
 Cocaine use during pregnancy
 Early rupture of membranes, which causes leaking amniotic fluid before the end of
pregnancy
 Infection inside of the uterus during pregnancy (chorioamnionitis)
 Being older, especially older than 40

4. What are the effects of Placental Abruption on the mother?

For the mother, placental abruption can lead to:

- Shock due to blood loss

- Blood clotting problems

- The need for a blood transfusion

- Failure of the kidneys or other organs resulting from blood loss

- Rarely, the need for hysterectomy, if uterine bleeding can't be controlled

5. What are the effects of Placental Abruption on the baby?

For the baby, placental abruption can lead to:

 Restricted growth from not getting enough nutrients

 Not getting enough oxygen
 Premature birth
 Stillbirth

6. What are the signs and symptoms of Placental Abruption?

Placental abruption is most likely to occur in the last trimester of pregnancy, especially in
the last few weeks before birth. Signs and symptoms of placental abruption include:

 Vaginal bleeding, although there might not be any

 Abdominal pain

 Back pain

 Uterine tenderness or rigidity

 Uterine contractions, often coming one right after another

7. What is the difference between Abruptio placenta and placenta previa?

-  With placenta abruptio, the placenta partially or completely detaches itself

from the uterine wall before delivery. With placenta previa, the placenta is located
over or near the cervix, in the lower part of the uterus.

8. What diagnostic test is done to confirm Abruptio Placenta?

- If your health care provider suspects placental abruption, he or she will do a physical
exam to check for uterine tenderness or rigidity. To help identify possible sources of
vaginal bleeding, your provider will likely recommend blood and urine tests and
ultrasound.

9. Make a drug study of the medications given to the patient.

10. Formulate at least 2 nursing diagnoses.

- Risk for Shock related to separation of the placenta

- Acute pain related to labor contractions during initial separation.

11. Formulate a Nursing Care Plan.

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