Abruptio placenta is premature separation of the normally implanted placenta after the

20th week of pregnancy, typically with severe hemorrhage. Placenta abruptio is a

problem with the placenta during pregnancy. The placenta is a round, flat organ that
forms during pregnancy to give the baby food and oxygen from the mother. During a
normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until
the baby has been born. But with placenta abruptio, the placenta breaks away, or abrupts,
from the wall of the uterus too early, before the baby is born. This problem can cause:

• Premature birth.
• Low birth weight.
• Major blood loss in the mother.

Placenta abruptio is also called abruptio placenta or placental abruption. It affects about 9
out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any
time after the 20th week of pregnancy. Placenta abruptio is also called abruptio placenta
or placental abruption. It affects about 9 out of 1,000 pregnancies. It usually occurs in the
third trimester, but it can happen at any time after the 20th week of pregnancy.

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.

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 Diagnosis

Acute pain

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.
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:

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.