ABRUPTION PLACENTA

• What trimester does abruptio placenta occur?

  3rd trimester: 20th week
• Abruptio placenta

  • a complication of late pregnancy or labor characterized by premature partial or complete separation of a normally implanted placenta. Also termed ACCIDENTAL HEMORRHAGE and ABLATIO PLACENTA
  • It is the second leading cause of bleeding in the 3rd trimester specifically on the 20th week
• PATHOPHYSIOLOGY

  • Where a part or all of the placenta separates/ detach from the wall of the uterus prematurely. Tearing of the placenta
• THE ROLES OF PLACENTA TO THE GROWING FETUS

  • Provides oxygenation
  • Provides nutrients in the form of blood
  • Serves fetal organ system, the major organ system – lungs, heart, brain
• What is the cause of abruptio placenta?

  unknown
• Risk factors

  • Multiparity
  • preeclampsia – pregnancy induced hypertension
  • previous cesarean section
  • Prom: premature rupture of the membranes
  • Trauma to the abdomen (e.g., fall or blow)
  • Infection in the uterus (e.g., Chorioamnionitis)
  • Older maternal age, especially 40 years old and above
  • Narcotics or nicotine use (e.g., tobacco smoking, cocaine)
  • Abnormally large placenta
  • Short umbilical cord
• SIGNS AND SYMPTOMS: DETACHED PLACENTA

  • Dark red vaginal bleeding
  • Extended fundal height due to the increasing uterine hematoma
  • Tenderness or rigidity of the uterus. Broadlike abdomen. COUVELAIRE SIGN
  • Abdominal pain and contractions: even back pain may be experienced suddenly
  • Concealed bleeding: the bleeding occurs inside the uterus and may lead to shock without seeing the extent of blood loss
• COMPLICATIONS

  • Hemorrhagic shock – due to severe loss of blood
  • Couvelaire uterus – board life abdomen. Rigid abdomen
  • Disseminated intravascular coagulation – dic. Problems in clotting and bleeding factor.
  • Cardiovascular accident from dic. Poor blood flow blood is constricted
  • Renal failure – multiple organ failure kidneys
  • Infection intrauterine
  • Premature delivery. Which is cause: 1. Fetal distress and 2. Fetal demise (DEATH)
• Does all fetal distress lead to fetal demise?

  NO
• NURSING MANAGEMENT

  • Start IVF: intravenous fluids. As ordered by the physician
  • Oxygen administration – to promote airway, breathing circulation to all vital organs of the body
  • FHT MONITORING/ well being with the use Doppler or stethoscope
  • Maintain left lateral position. To prevent vena cava syndrome
  • Never perform internal examination – may rupture the placenta and will cause severe bleeding
• NURSING MANAGEMENT (2)

  • Monitoring of V/S, FHT, LABOR ONSET and PROGRESS OF LABOR (DURATION, FREQUENCY, INTENSITY AND INTERVAL)
  • MIO – adequate intake equate adequate output!
  • Uterine pain monitoring
  • Monitor bleeding that may lead to shock
  • Provide emotional support
  • Prepare for emergency delivery cesarean section. NO NSVD
• DEGREE OF SEPARATION

  0 – NO SYMPTOM of apparent separation from the maternal surface

  1 – MINIMAL SEPARATION, positive vaginal bleeding. Monitor further signs of hemorrhage, no fetal distress

  2 – MODERATE SEPARATION, positive fetal distress, uterus is tensed, painful on palpation

  3 – EXTREME SEPARATION, maternal death – MATERNAL HYPOVOLEMIC SHOCK results to fetal death