Abruptio Placenta - Nursing Case Study

by - June 24, 2020

 
DESCRIPTION:
Abruptio placentae or also known as premature separation of the placenta is when the placenta have been implanted correctly but suddenly in begins to separate and bleeds. This situation can cause extensive bleeding that makes it the most frequent cause of perinatal death.
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS):
The pregnant women will experience a sharp stabbing abdominal pain during the initial separation. Then if labor is starting with separation, each contraction will be accompanied with pain over and above of the contraction. Uterine tenderness and rigidity will be felt too upon palpation.  There will be vaginal bleeding although it may not be readily apparent. External bleeding will be only evident if the placenta separates first at the edges because the blood will escape freely from uterus to cervix but if the center of the placenta separate first, the blood will pool under the placenta and it will be hidden from the view. Whether the blood is evident or not, signs of maternal hypovolemic shock usually follows quickly. Couvelaire uterus or uteroplacental apoplexy forming a hard, boardlike uterus will occur. The pregnant mother will also experience DIC or Disseminated Intravascular Coagulation Syndrome since her reserve blood fibrinogen is diminishing in order to accomplish effective clot formation.

DIAGNOSTIC AND LABORATORY TEST:
Initial blood work should be included and these are hemoglobin level, typing and cross – matching, and fibrinogen level and fibrin breakdown products to detect DIC.

RISK FACTORS:
The risk factors that are identified in this case are high parity, advanced maternal age, short umbilical cord, chronic hypertensive disease, hypertension of pregnancy, direct trauma from automobile accident or intimate partner violence, vasoconstriction from cocaine or cigarette use, thrombophilic conditions that lead to thrombosis formation, chorioamnionitis or infection of the fetal membranes and fluid.

PATHOPHYSIOLOGY:
NURSING DIAGNOSES BY PRIORITY:
Deficient fluid volume related to heavy bleeding related to placental abruption
Acute pain related to placental separation
Fear related to threat of death to fetus and self
Risk for shock as possibly evidenced by hypovolemia
Risk for disturbed Maternal – Fetal Dyad as possibly evidenced by risk factors of complication of pregnancy.

NURSING CARE PLAN:
Deficient fluid volume related to heavy bleeding related to placental abruption
Acute pain related to placental separation
Fear related to threat of death to fetus and self
NURSING MANAGEMENT / INTERVENTION:
If a pregnant woman is admitted in the hospital after experiencing the said symptoms, the nurse need to assess the time of bleeding began and whether there is a pain accompanied with it. The amount and kind of bleeding should be noted and her actions to detect trauma that could have led to placenta separation should be know too. The nurse should also monitor the fetal heart sounds and maternal vital signs for every 5 to 15 minutes to establish baselines and observe progress. The baselines fibrinogen determination will be followed by additional determinations up to the time of birth. The woman should be in a lateral position to prevent pressure in the vena cava and additional interference with fetal circulation. Any abdominal, vaginal, or pelvic examination should not be done so the injured placenta will not be disturbed.

MEDICAL / SURGICAL MANAGEMENT:
This condition is an emergency situation so with that the woman need a large – gauge intravenous catheter inserted for fluid and replacement and oxygen mask to limit fetal anoxia. If the separation is minimal, the pregnancy must be ended because the fetus cannot obtain adequate oxygen and nutrients and if vaginal both is not seen imminent, cesarean birth may pose a grave risk because of a possibility of hemorrhage during the surgery and from the surgical incision. Intravenous administration of fibrinogen or cryoprecipitate can be used to elevate a woman’s fibrinogen level prior to and concurrently with surgery. And for the worst outcome, a hysterectomy might be done in order to prevent exsanguination.

REFERENCES:

  • Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2016). Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales. Philadelphia, Pennsylvania: F.A. DAVIS COMPANY
  • Potter et. Al (2017). Fundamentals of Nursing (9th ed.). Singapore: Elsevier Inc.

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