Abruptio Placentae

Abruptio Placentae Nursing Diagnosis Interventions and Care Plans

Abruptio Placentae NCLEX Review Care Plans

Nursing Study Guide for Abruptio Placentae

The placenta is a highly vascular organ that develops within the walls of the uterus during pregnancy and fetal development.

This structure is primarily responsible for the supply of oxygen and nutrients to the fetus.

Given the importance of its role for fetal development, any deviations to the placenta’s integrity will cause undue harm for both the mother and the unborn child.

One obstetric example of such complications is Abruptio placentae (placental abruption). It is a medical condition characterized by the displacement, either partially or fully, of the placenta against the inner uterine wall.

Abruptio placentae is uncommon; however, it posts such great risks to the mother and fetus.

It occurs unexpectedly, oftentimes needing immediate medical intervention for it endangers the mother and her unborn child.

Signs and Symptoms of Abruptio Placentae

Abruptio placentae usually occurs at the third trimester or a few weeks before giving birth.  The classic triad of the clinical manifestation of Abruptio placentae are:

  1. Vaginal bleeding – varies in amount and is present in 80% of patients diagnosed of placental abruptions; the remaining 20% are those with concealed hemorrhages
  2. Abdominal/uterine tenderness or rigidity and back pain – occurs suddenly; sometimes severe
  3. Abnormal uterine contractions – completes the triad of Abruptio placentae; usually continuous in nature, one contraction coming after another

It is important to note that the absence of vaginal bleeding does not rule out the diagnosis of Abruptio Placentae.

Causes and Risk Factors Abruptio Placentae

The etiology of Abruptio Placentae is unknown.

Possible causes include trauma or injury to the abdomen due to an accident.

It can also result from oligohydramnios, which is the rapid low levels of amniotic fluid.

The risk factors that increase the likelihood of Abruptio Placentae include:

  1. History of abruptio placentae that is not cause by traumatic abdominal injury
  2. Chronic hypertension
  3. Hypertension-related problems during preeclampsia, eclampsia, HELLP syndrome (which stands for Hemolysis, Elevated liver enzymes and Low Platelet levels)
  4. Abdominal trauma – usually due to fall
  5. Smoking
  6. Drug abuse during pregnancy – specifically cocaine
  7. Early rupture of membranes
  8. Chorioamnionitis – intrauterine infection during pregnancy
  9. Age – mothers aged 40 and above

Complications of Abruptio Placentae

Abruptio placentae impose a variety of complications that are life-threatening for both the mother and her unborn child.

Maternal complications may lead to:

  1. Hypovolemic shock
  2. Blood clotting problems that may lead to DIC (Disseminated Intravascular Coagulation)
  3. Multi-organ failure as result of insufficient blood supply in the circulation.
  4. Hysterectomy, or the surgical resection of the uterus. This is done to prevent more blood loss brought upon by Abruptio Placentae.

Fetal complications may lead to:

  • Stunted and insufficient growth of the fetus
  • Hypoxia due to rupture of primary source of oxygen
  • Prematurity
  • Still birth

Diagnosis of Abruptio Placentae

  • Complete Blood Count or CBC – to determine hemodynamic status but not necessarily predicts acute blood loss
  • Fibrinogen studies – to check for fibrinogen levels; fibrinogen levels of 200mg/dl or below is highly suggestive of severe abruption and would necessitate transfusion of fresh frozen plasma or cryoprecipitate
  • Prothrombin time (PT) activated partial thromboplastin time (APTT) – to check for coagulation status that is needed prior corrective surgery
  • Blood Urea nitrogen (BUN)/ creatinine –to monitor renal function
  • Blood and Rh types – to prepare the patient for the possibility of blood transfusions due to bleeding.
  • Kleihauer-Betke test – to determine the volume of fetal blood transfused into the maternal circulation. This will also determine the appropriate dosage of Rh (D) immune globulin for significant fetal-maternal hemorrhage.
  • Ultrasound – to eliminate differential diagnoses of third trimester bleeding besides Abruptio Placentae.
  • Non-stress test / external fetal monitoring – to assess general fetal condition. Late decelerations and fetal bradycardia are indicative of fetal distress. Furthermore, increased uterine resting tone, along with frequent contractions, may progress to hyperstimulation of the uterus.
  •  Biophysical profile – to evaluate patients with chronic abruptions, who are managed conservatively. BPP scores of 6 and below (from a maximum score of 10) is an early sign of fetal distress and compromise.

Treatment for Abruptio Placentae

The management of Abruptio placentae includes careful planning, initial control of symptoms, the manner of fetal delivery, dietary and lifestyle modification, and the use of tocolytics.

  1. Hospitalization. Due to the nature of the condition, consideration of inpatient admission to a hospital with ICU and neonatal ICU is warranted before fetal delivery. Monitoring for fetal heart tones and contractions, stabilizing hemodynamic status through fluid resuscitation or blood transfusions, correction of coagulopathy, administration of Rh immune globulin (if patient is Rh negative) and initiation of corticosteroid for fetal lung maturity (for less than 37 weeks gestation) are implemented as initial treatment measures.
  2. Manner of Fetal Delivery. Choosing between vaginal delivery or through Caesarian section is based on the stability of the mother’s health. Caesarian section is the standard approach to stabilize the maternal and fetal health. Also, during C-section can the surgeon properly address and control the bleeding brought about by the condition. Placing the patient on “Nothing By Mouth” (NBM or NPO) is necessary to prepare the patient for emergent delivery. A modified bedrest regimen is prescribed to limit maternal and fetal distress.
  3. Medications. The following medications can be considered in a patient with Abruptio placentae:
  4. Tocolytics or anti-contraction drugs – used for premature labor suppression. Tocolysis is controversial and is only considered for patients hemodynamically stable and have no evidence of fetal threat.
  5. Calcium channel blockers – utilizing this prohibits the influx of calcium to the uterine walls, thus decreasing contractions
  6. Magnesium sulfate – drug of choice for managing Abruptio placentae. Also acts as neuroprotection for maternal seizures
  7. Corticosteroids – used to aide in lung maturity for preterm fetus with abruptions

Nursing Care Plans for Abruptio Placentae

Nursing Care Plan 1

Nursing Diagnosis: Altered Uteroplacental Tissue Perfusion related to maternal bleeding secondary to abruptio placentae, as evidenced by vaginal bleeding, abnormal uterine contractions, abdominal and uterine tenderness and pain, and changes in fetal heart rate

       Desired Outcome: Patient has stable vital signs and the baby has a stable fetal heat rate.

InterventionsRationales
Admit the patient and perform close monitoring for both the mother and the baby.  Decrease in fetal activity may mean fetal compromise or distress, which requires immediate medical attention and monitoring through hospitalization.
Provide the necessary treatments for maternal hemodynamic stabilization such as intravenous fluid resuscitation or blood transfusion.Monitoring for fetal heart tones and contractions, stabilizing hemodynamic status through fluid resuscitation or blood transfusions, correction of coagulopathy, and administration of Rh immune globulin (if patient is Rh negative).
Administer corticosteroid as prescribed.Administer corticosteroid for fetal lung maturity (for less than 37 weeks gestation) as an initial treatment measure.
Encourage the pregnant patient to follow a healthy lifestyle, such as smoking cessation and avoidance of illegal drug use, proper hydration, enough sleep, and appropriate diet.Fetal movement and activity can be affected by cigarette smoking, drug abuse, dehydration, sleep deprivation, and poor dietary choices.
Monitor fetal growth by measuring the fundus and check fetal heart rate at each clinic visit.To determine if the baby is experiencing intrauterine growth retardation related to abruptio placentae.  
If the baby needs to be delivered prematurely, give IM corticosteroids as prescribed, not more than 7 days prior to expected date of delivery.To enhance the production of surfactants which are necessary to speed up the pulmonary maturity of the fetus and avoid respiratory distress syndrome.

Nursing Care Plan 2

Nursing Diagnosis: Deficient Fluid Volume related to active blood loss secondary to abruptio placentae, as evidenced by an average blood pressure level of 85/50, body weakness, decreased urinary output, decreased fetal heart rate, and pale, clammy skin

Desired Outcome: The patient will re-establish a functional body fluid volume and a balanced input and output status.

InterventionRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, low blood pressure, and pain are associated with the mother’s blood loss. Fluid retention may be evident if the mother has a weight gain of more than 1.5kg/month during the 2nd trimester, or more than 0.5 kg/week during the 3rd trimester.
Start input and output monitoring.To monitor circulatory blood volume. To ensure that the mother has adequate oral hydration or if there is a need to commence IV hydration therapy.  
Speak to the patient and family about the need for hospitalization for severe abruptio placentae or serious hemorrhage.To closely monitor the symptoms of abruptio placentae and deficient fluid volume in the appropriate setting.
Prepare the patient for C-section and surgical intervention related to maternal bleeding. Place the patient on a nothing by mouth (NBM or NPO) status.For heavy bleeding, immediate C-section will be performed, regardless if the fetus   is premature or in full term. Corrective surgery to control the bleeding will also be done and may involve some surgical techniques as appropriate. Placing the patient on “Nothing By Mouth” (NBM or NPO) is necessary to prepare the patient for emergent delivery. A modified bedrest regimen is prescribed to limit maternal and fetal distress.
Prepare for blood transfusion as required.To increase blood volume.  
Refer the patient to a dietitian for proper monitoring and advice of salt, caloric and protein intake.Consuming salt between 2 to 4 g per day is ideal as an extremely low salt intake may increase dehydration, while high salt intake may cause edema formation.

Other Nursing Diagnoses:

  • Acute Pain
  • Risk for Shock
  • Fear related to threat of fetal death

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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