Laserna, Chelziah Mica M. Prof.

Cunanan
BSN 2-2 RLE Group E1

ABRUPTIO PLACENTA

In normal circumstances, the placenta is attached to uterine wall, providing the baby with
nutrients and oxygen as well as removing fetal waste products. It is usually expelled naturally
after the is delivered as part of the “afterbirth”

Placental abruption happens when the placenta separates prematurely from the uterine wall. It
usually occur in the third trimester, but can occur as early as 20 weeks gestation.

Pathophysiology
 The placenta has implanted in the correct location.
 For some unknown reasons, it suddenly begins to separate, causing bleeding.
 This separation would occur late in pregnancy, and accounts for 10% of perinatal deaths.

Risk factors
 High parity – a woman who has given birth multiple times predisposes herself to
abruptio placentae.
 Short umbilical cord – a short umbilical cord could cause the separation of the placenta
especially if trauma occurs.
 Advanced maternal age – women over the age of 35 years old have higher risk of
acquiring abruptio placentae.
  Direct trauma – any trauma to the abdomen could cause a separation of the placenta.
 Chorioamnionitis – an infection of the fetal membranes and fluid that could predispose
the woman to premature placental separation.

Types
The types of abruption placenta are measured according to the degree of placental separation that
has occurred.
 Grade 0 – no indication of placental separation and diagnosis of slight separation is made
after birth
 Grade 1 – there is minimal separation which causes vaginal bleeding, but no changes in
fetal vital signs occur.
 Grade 2 – moderate separation occurs and fetal distress is already evident. The uterus is
also hard and painful upon palpation.
 Grade 3 – extreme separation; maternal shock and fetal death is imminent if no
interventions are done.

Signs and symptoms

 Sharp, stabbing pain. A woman may experience the pain on the upper uterine fundus as
initial separation occurs.
 Heavy bleeding. This usually happens after the separation of the placenta. External
bleeding will only occur if the placenta separates first from the edges. Internal bleeding
will occur if placenta separates from the center because blood would pool under it.
 Uterus is tense and rigid. Most often called as Couvelaire uterus, it appears as a board-
like, hard uterus without any bleeding.

Diagnostic tests
 Hemoglobin level and fibrinogen level. These tests are performed to rule out
disseminated intravascular coagulation (DIC) or a coagulation disorder that prompts
overstimulation of the normal clotting cascade and results in simultaneous thrombosis
and hemorrhage.
Medical Management
These medical procedures are implemented for both the mother and the fetus in order to avoid
worsening the condition.
 Intravenous therapy – once the woman starts to bleed, the physician would order a large
gauge catheter to replace fluid losses.
 Oxygen inhalation – delivered via face mask, this would prevent fetal anoxia.
 Fibrinogen determination – this test would be taken several times before birth to detect
DIC.

Surgical Management
Once the condition has reached a stage that might endanger the life of both patients, surgical
management is put into action.
 Cesarean delivery – if birth is imminent, it is safest to deliver the baby via cesarean
delivery.
 Hysterectomy – the worst outcome would be for the woman to develop DIC, and to
prevent exsanguinations, hysterectomy must be performed.

Nursing Management
A vital role is also upheld by the nurses during this situation. Their accurate assessment would be
one of the baseline data for all health care providers to plot the care plan for the patient.

1. Nursing Assessment
a. Assess for signs of shock, especially when heavy bleeding occurs.
b. Assess if the bleeding is external or internal.
c. Monitor contractions if separation occurs during labor.
d. Obtain baseline vital signs.
e. Assess for the time the bleeding began, the amount and kind of bleeding,
and interventions done when bleeding occurred if it started before
admission.
f. Assess for the quality of pain.
2. Nursing Diagnosis
a. Deficient fluid volume related to bleeding during premature placental
separation.
3. Nursing Interventions
a. Place the woman in a lateral, not supine position to avoid pressure in the
vena cava.
b. Monitor fetal heart sounds.
c. Monitor maternal vital signs to establish baseline data.
d. Avoid performing any vaginal or abdominal examinations to prevent
further injury to the placenta.
4. Evaluation
a. Maternal vital signs are all within normal range, especially the blood
pressure.
b. Urine output should be more than 30mL/hr.
c. No bleeding or minimal amount of bleeding observed.
d. Uterus is not tense and rigid.
e. Fetal heart sounds are within normal range.