Abruptio Placenta

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Abruptio Placenta
2011-11-28 14:27:52
Abruptio Placenta

Abruptio Placenta
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  1. Overview of Abruptio Placenta
    premature separation of the placenta from the uterus, which can be a partial or complete detachment

    separation occurs after 20 weeks of gestation, which is usually in the third trimester. I has significant maternal and fetal morbidity and mortality and is a leading cause of maternal death

    Coagulation defect, such as disseminated intravascular coagulapathy, is often associated with moderate to severe abruption
  2. Risk for Abruptio Placenta
    • Maternal Hypertention
    • Blunt external abdominal trauma (motor vehicle crash, maternal battering)
    • Cocaine abuse resulting in vasoconstriction
    • Previous incidents of abruptio placenta
    • cigarette smoking
    • premature repture of membranes
    • short umbilical cord
    • Multifetal pregnancy
    • high parity (number of pregnancies)
    • advance maternal age
  3. Assessment findings for Abruptio Placenta
    • Subjective data:
    • sudden onset of intense localized uterine pain with bright red vaginal bleeding

    • Objective data:
    • vaginal bleeding that is bright red or dark
    • a board-like abdomen that is tender
    • a firm, rigid uterus with contractions (uterine hypertonicity)
    • fetal distress
    • signs of hypovolemic shock

    • Laboratory test:
    • Hgb and Hct decreased
    • Coagulation factors decreased
    • Clotting defects (disseminated intravascular coagulation)
    • Cross and type match for possible blood transfusions
    • Kleihauer-Betke test (used to detect fetal blood in maternal circulation)

    • Diagnostic proceedures:
    • Ultrasound for fetal well-being and placental assessment
    • Biophysical profile to ascertain fetal well-being
  4. Collaborative care for patients who are experiencing Abruptio Placenta
    • Nursing care:
    • palpate the uterus for tenderness and tone
    • assess FHR pattern
    • refrain from vaginal exams (may exacerbate bleeding)
    • administer IV fluids as perscribed
    • administer Oxygen 8 to 10 liters via face mask

    • Medication:
    • administer blood products and fluid volume replacements to maintain the client's urine out put at 30 mL/hr or more and Hct at 30% or greater
    • administer corticosteroids to promote fetal lung maturity (betamethasone [Celestone])

    Provide emotional support for the patient and family

    expected outcomes: birth of a viable neonate