Nursing Care Plan – Abruptio Placenta
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.
- Uterine anomalies
- Previous cesarean delivery
- Renal or vascular disease
- Trauma to the abdomen
- Previous third semester bleeding
- Abnormally large placenta
- Short umbilical cord
Common Clinical Manifestations:
- Intense, localized uterine pain, with or without vaginal bleeding
- Concealed or external dark red bleeding
- Uterus firm to boardlike, with severe continuous pain
- Uterine contractions
- Uterine outline possibly enlarged or changing shape
- FHR present or absent
- Fetal presenting part may be engaged
- Continuous evaluate maternal and fetal physiologic status, particularly:
- Vital Signs
- 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.
- 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.
- 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
- Provide client and family teaching.
- 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.