Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae also called placental abruption occur when the placenta prematurely separates from the uterine wall, usually after the 20th week of gestation, producing hemorrhage. This disorder may be classified according to the degree of placental separation and the severity of maternal and fetal symptoms. It is characterized by a triad of symptoms: vaginal bleeding, uterine hypertonus, and fetal distress. It can occur during the prenatal or intrapartum period

Abruptio placentae is most common in multigravidas usually in women older than age 35 and is a common cause of bleeding during the second half of pregnancy. On heavy maternal bleeding generally necessitates termination of the pregnancy. The fetal prognosis depends on the gestational age and amount of blood lost. The maternal prognosis is good if hemorrhage can be controlled.

Grading System for Abruptio Placentae (placenta abruption)

Grade 0 Less than 10% of the total placental surface has detached; the patient has no symptoms; however, a small retroplacental clot is noted at birth.

Grade I approximately 10%–20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress.

Grade II Approximately 20%–50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock.

Grade III More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

Central abruption, the separation occurs in the middle, and bleeding is trapped

Between the detached placenta and the uterus, concealing the hemorrhage.

Marginal abruption, separation begins at the periphery and bleeding accumulates between

The membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage.

Causes for Abruptio Placentae (placenta abruption)

The cause of abruptio placentae is unknown; however, any condition that causes vascular changes at the placental level may contribute to premature separation of the placenta. Predisposing factors include:

• Traumatic injury.
• Placental site bleeding from a needle puncture during amniocentesis,
• Chronic or pregnancy induced hypertension.
• Multiparity
• Short umbilical cord
• Dietary deficiency
• Smoking
• Advanced maternal age
• Pressure on the vena cava from an enlarged uterus.

The spontaneous rupture of blood vessels at the placental bed may result from a lack of resiliency or to abnormal changes in the uterine vasculature. The condition may be complicated by hypertension or by an enlarged uterus that can't contract sufficiently to seal off the torn vessels. Consequently, bleeding continues unchecked, possibly shearing off the placenta partially or completely.

Complications for Abruptio Placentae (placenta abruption)

• Hemorrhage and shock.
• Renal failure,
• Disseminated intravascular coagulation.
• Maternal and fetal death.

Nursing Assessment Nursing Care Plans for Abruptio Placentae (placenta abruption)

Abruptio placentae produces a wide range of clinical effects, depending on the extent of placental separation and the amount of blood lost from maternal circulation.

Obtain patient history obstetric history. Determine the date of the last menstrual period to calculate the estimated day of delivery and gestational age of the infant. Inquire about alcohol abuse, tobacco, and drug usage, and any trauma or abuse situations during pregnancy

• Mild abruptio placentae with marginal separation usually report mild to moderate vaginal bleeding, vague lower abdominal discomfort, and mild to moderate abdominal tenderness.
• Moderate abruptio placentae are about 50% placental separation usually report continuous abdominal pain and moderate, dark red vaginal bleeding. Onset of symptoms may be gradual or abrupt. Vital signs may indicate impending shock. Palpation reveals a tender uterus that remains firm between contractions.
• Severe abruptio placentae about 70% placental separations patient usually report abrupt onset of agonizing, unremitting uterine pain (described as tearing or knifelike) and moderate vaginal bleeding. Vital signs indicate rapidly progressive shock. Palpation reveals a tender uterus with boardlike rigidity. Uterine size may increase in severe concealed abruptions.

Psychosocial Assessment to understanding patient’s situation and also the significant other’s degree of anxiety, coping ability, and willingness to support the patient

Diagnostic tests for Abruptio Placentae (placenta abruption)

• Pelvic examination under double setup
• Ultrasonography
• Decreased hemoglobin level
• Decreased platelet count.
• Periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and in detecting DIC.

Treatment for Abruptio Placentae (placenta abruption)

Medical Treatment management goals of abruptio placentae are to assess, control, and restore the amount of blood lost and to deliver a viable infant and prevent coagulation disorders.

Nursing diagnoses Nursing Care Plans for Abruptio Placentae (placenta abruption)

Primary nursing diagnosis nursing care plans for abruptio placentae (placenta abruption) fluid volume deficit related to blood loss

Common nursing diagnosis fond in Nursing Care Plans for Abruptio Placentae (placenta abruption):

• Acute pain
• Anxiety
• Deficient fluid volume
• Dysfunctional grieving
• Fear
• Ineffective coping
• Ineffective tissue perfusion: Cardiopulmonary

Nursing Key outcomes, interventions, and Patient teaching Nursing Care Plans for Abruptio Placentae (placenta abruption)