Maneja, Jan Michael B.

BSN 223
Placenta abruptio
Alternative Names

• Premature separation of placenta; Ablatio placentae; Abruptio

placentae; Placental abruption

Placenta abruptio is defined as the premature separation of the placenta

from the uterus.

Patients with abruptio placentae typically present with

*bleeding

*uterine contractions

*fetal distress

A significant cause of third-trimester bleeding associated with both fetal and

maternal morbidity and mortality.

Causes:

• Abnormally short umbilical cord

• Injury to the belly area (abdomen) from a fall or automobile accident
• Sudden loss in uterine volume (can occur with rapid loss of amniotic
fluid or the delivery of a first twin)
 • Trauma

• Thrombophili

Risk factors include:

• Advanced maternal age

• Cigarette smoking
• Cocaine use
• Diabetes
• Drinking more than 14 alcoholic drinks per week during pregnancy
• High blood pressure during pregnancy -- About half of placental
abruptions that lead to the baby's death are linked to high blood
pressure
• Increased uterine distention (as may occur with multiple pregnancies
or abnormally large volume of amniotic fluid)
• Large number of prior deliveries

• Previous placental abruption

• Chorioamnionitis
• Prolonged rupture of membranes (24 h or longer)
• Pre-eclampsia
• Hypertension
• Maternal age of 35 years or older
• Male fetal sex
• Low socioeconomic status
• Elevated second trimester maternal serum alpha-fetoprotein
(associated with up to a 10-fold increased risk of abruption)

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

Symptoms

• Abdominal pain
• Back pain
• Vaginal bleeding
Exams and Tests

• Abdominal ultrasound
• CBC (0Complete blood count)
• Fibrinogen level
• Partial thromboplastin time
• Pelvic exam
• BUN (Blood urea nitrogen)
• Kleihauer-Betke test - help detect fetal red blood cells in the maternal
circulation.
• Nonstress test
• Bio physical Profile (BPP) - help evaluate patients with chronic
abruptions who are being managed conservatively

Treatment
A. Treatment may fluids through a vein (IV) and blood transfusions.
B. The mother will be carefully monitored for symptoms of shock and the
unborn baby will be watched for signs of distress, which includes an
abnormal heart rate.
C. An emergency cesarean section may be necessary. If the fetus is very
immature and there is only a small placenta rupture, the mother may
be kept in the hospital for close observation and released after several
days if the condition does not get worse
D. If the fetus is developed (matured) enough, vaginal delivery may be
chosen if there is minimal distress to the mother and child. Otherwise,
a cesarean section may be the preferred choice.

The following increase the risk for death in both the mother and
baby:

• Absence of labor
• Closed cervix
• Delayed diagnosis and treatment of placenta abruption
• Excessive blood loss resulting in shock
• Hidden (concealed) vaginal bleeding in pregnancy

Possible Complications

• Excessive loss of blood may lead to shock

 • Possible death in the mother or baby.

• If bleeding occurs after the delivery and blood loss cannot be

controlled by other means, a hysterectomy (removal of the uterus)
may become necessary.

Prevention

• Avoid drinking, smoking, or using recreational drugs during pregnancy.

Get early and continuous prenatal care.

• Early recognition and proper management of conditions in the mother

such as diabetes and high blood pressure also decrease the risk of
placenta abruptio.

Medications
*Tocolytics
May allow for effective administration of glucocorticoids to the preterm fetus
to accelerate fetal lung maturation. In chronic abruption, may also help delay
delivery to a gestational age when complications of prematurity are less
severe.

*Nifedipine (Adalat, Procardia, Afeditab, Nifediac)

A calcium channel blocker. The theory behind use as tocolytic is that by

blocking influx of calcium into uterine muscle cells, it will decrease
contractions, which are dependent on calcium.

*Magnesium Sulfate

Nursing Management

1. Continuous evaluate maternal and fetal physiologic status, particularly:

o Vital Signs
o Bleeding
o Electronic fetal and maternal monitoring tracings
o Signs of shock – rapid pulse, cold and moist skin, decrease in
blood pressure
o Decreasing urine output
o 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.
 o On admission, place the woman on bed rest in a lateral position
to prevent pressure on the vena cava.
o Insert a large gauge intravenous catheter into a large vein for
fluid replacement. Obtain a blood sample for fibrinogen level.
o Monitor the FHR externally and measure maternal vital signs
every 5 to 15 minutes. Administer oxygen to the mother by
mask.
o 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.