Nursing Care Plan - Abruptio Placenta

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

Two types of abruption placentae:

Concealed hemorrhage - the placenta separation centrally, and a large amount of blood is accumulated under the placenta.

External hemorrhage - the separation is along the placental margin, and blood flows under the membranes and through cervix.

Risk Factors:

1. Uterine anomalies
2. Multiparity
3. Preeclampsia
4. Previous cesarean delivery
5. Renal or vascular disease
6. Trauma to the abdomen
7. Previous third semester bleeding
8. Abnormally large placenta
9. Short umbilical cord

Common Clinical Manifestations:

1. Intense, localized uterine pain, with or without vaginal bleeding
2. Concealed or external dark red bleeding
3. Uterus firm to boardlike, with severe continuous pain
4. Uterine contractions
5. Uterine outline possibly enlarged or changing shape
6. FHR present or absent
7. Fetal presenting part may be engaged

Nursing Management:

1. Continuous evaluate maternal and fetal physiologic status, particularly:
   • Vital Signs
   • Bleeding
   • Electronic fetal and maternal monitoring tracings
   • Signs of shock - rapid pulse, cold and moist skin, decrease in blood pressure
   • Decreasing urine output
   • Never perform a vaginal or rectal examination or take any action that would stimulate uterine activity.
2. Asses the need for immediate delivery. If the client is in active labor and bleeding cannot be stopped with bed rest, emergency cesarean delivery may be indicated.
3. Provide appropriate management.
   • On admission, place the woman on bed rest in a lateral position to prevent pressure on the vena cava.
   • Insert a large gauge intravenous catheter into a large vein for fluid replacement. Obtain a blood sample for fibrinogen level.
   • Monitor the FHR externally and measure maternal vital signs every 5 to 15 minutes. Administer oxygen to the mother by mask.
   • Prepare for cesarean section, which is the method of choice for the birth
4. Provide client and family teaching.
5. Address emotional and psychosocial needs. Outcome for the mother and fetus depends on the extent of the separation, amount of fetal hypoxia and amount of bleeding.

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