Chapter 11: Placental Abruption

Question 1

What is Placental Abruption (Abruptio Placentae)?

Answer 1

Hemorrhagic disorder
>the premature separation of a normally implanted placenta from the decidual lining of the uterus after 20 weeks gestation
>an abruption results in hemorrhage between the uterine wall and the placenta

Question 2

Etiology

Answer 2

at the initial point of placental separation, nonclotted blood courses from the site of injury

• the enlarging collection of blood may cause further separation of the placenta
• bleeding can be concealed (internal) or revealed (apparent)

Question 3

A concealed hemorrhage/abruption

Answer 3

an abruption in which the bleeding is confined within the uterine cavity

Question 4

A revealed/external hemorrhage/abruption

Answer 4

most common abruption

-the blood dissects downward toward the cervix

Question 5

Risk Factors

Answer 5

• maternal hypertension (chronic, gestational, pre-eclampsia/eclampsia)
• cigarette smoking
• multiparity
• abortions (spontaneous, elective)
• illicit drug use (cocaine, methamphetamine)
• short fetal umbilical cord
• maternal abdominal trauma
• rupture of the membranes
• uterine leiomyoma (fibroids) located behind the placenta

Question 6

Signs and Symptoms

Answer 6

third trimester bleeding associated with severe abdominal pain

• uterine tenderness
• abdominal or back pain
• a board-like abdomen with no vaginal bleeding
• abnormal contractions and increased uterine tone
• fetal compromised e/b late fetal heart rate (FHR) decelerations
• bradycardia and lack of variability on the electronic fetal heart monitor
• fetal demise

Question 7

Diagnosis

Answer 7

vaginal bleeding in the third trimester of pregnancy is the hallmark
>made by clinical findings and, when available, ultrasound examination

Question 8

Hallmark of Placental Abruption

Answer 8

vaginal bleeding in the third trimester of pregnancy

Question 9

Management

Answer 9

Delivery; the potential for rapid deterioration (hemorrhage, disseminated intravascular coagulation (DIC), and fetal hypoxia) necessitates delivery
>some abruptions are small and non-catastrophic and do not necessitate immediate delivery
>hospitalization, laboratory studies, continuous monitoring, and ongoing patient support should be initiated when placental abruption is suspected

Question 10

What to do When Placental Abruption is suspected

Answer 10

hospitalization, laboratory studies, continuous monitoring, and ongoing patient support

Question 11

Care for a Patient Experiencing Abruptio Placentae

Answer 11

• Hospitalization
• IV placement with a large bore catheter (16-gauge)
• Labwork
• Betamethasone (speed lung maturity in infant; given to mom)
• Rh(D)-negative patients to receive RhoGAM to prevent isoimmunization
• continuous evaluation of intake and output
• continuous electronic fetal monitoring
• delivery (cesarean or vaginal) initiated depending on the status of mother and fetus
• nursing care centered on continuous maternal-fetal assessment, with ongoing information and motional support for the patient and her family

Question 12

Labwork

Answer 12

• CBC
• coagulation studies (fibrinogen, PT, PTT, platelet count, and fibrin degradation products)
• type and screen for 4 units of blood
• Kleihauer-Betke for Rh(D)-negative patients
• a “clot test” may be performed; a red top tube of blood is drawn, set aside, and checked for clotting. If a clot does not form within 6 minutes or if it forms and lyses within 30 minutes, a coagulation defect is probably present and the fibrinogen level is less than 150 mg/dL