INTRODUCTION

Placental abruption (also known as abruptio placentae) is an obstetric catastrophe (complication

of pregnancy), wherein the placental lining has separated from the uterus of the mother. It is the
most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation
after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies world wide with a
fetal mortality rate of 20-40% depending on the degree of separation. Placental abruption is also
a significant contributor to maternal mortality. Many women can die from this type of
abnormality. The heart rate of the fetus can be associated with the severity.
Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain
with or without bleeding. The fundus may be monitored because a rising fundus can indicate
bleeding. An ultrasound may be used to rule out placenta praevia but is not diagnostic for
abruption. The mother may be given Rhogam if she is Rh negative.
Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than
36 weeks and neither mother or fetus are in any distress, then they may simply be monitored in
hospital until a change in condition or fetal maturity whichever comes first.
Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother
are in distress. Blood volume replacement and to maintain blood pressure and blood plasma
replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over
caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of
disseminated intravascular coagulation. Patient should be monitored for 7 days for PPH.
Excessive bleeding from uterus may necessitate hysterectomy if family size is completed.

PATIENT PROFILE

• Ward: MCM-DR
• Date of Admission: May 23, 2010
• Patients Name: B.C.
• Address: Pandacan .
• Age: 35 years old
• Gender: Female
• Birth Date: November 15, 1975
• Educational status: High school undergraduate
• Religion: Roman Catholic
• Nationality: Filipino
• Civil Status: Married
• Occupation:Housewife
• Health Care Financing: Phil Health
• Informant: Patient
• Reliability: 100%

ANATOMY AND PHYSIOLOGY

Female Reproductive System
Most species have 2 sexes: male and female. Each sex has its own unique reproductive system.
They are different in shape and structure, but both are specifically designed to produce, nourish,
and transport either the egg or sperm.

Unlike the male, the human female has a reproductive system located entirely in the pelvis. The
external part of the female reproductive organs is called the vulva, which means covering.
Located between the legs, the vulva covers the opening to the vagina and other reproductive
organs located inside the body.

The fleshy area located just above the top of the vaginal opening is called the mons pubis. Two
pairs of skin flaps called the labia (which means lips) surround the vaginal opening. The clitoris,
a small sensory organ, is located toward the front of the vulva where the folds of the labia join.
Between the labia are openings to the urethra (the canal that carries urine from the bladder to the
outside of the body) and vagina. Once girls become sexually mature, the outer labia and the
mons pubis are covered by pubic hair.

A female's internal reproductive organs are the vagina, uterus, fallopian tubes, and ovaries.

The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. The
vagina is about 3 to 5 inches (8 to 12 centimeters) long in a grown woman. Because it has
muscular walls, it can expand and contract. This ability to become wider or narrower allows the
vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina's
muscular walls are lined with mucous membranes, which keep it protected and moist. The vagina
serves 3 purposes: It's where the penis is inserted during sexual intercourse, and it's also the
pathway that a baby takes out of a woman's body during childbirth, called the birth canal, and it
provides the route for the menstrual blood (the period) to leave the body from the uterus.

A thin sheet of tissue with 1 or more holes in it called the hymen partially covers the opening of
the vagina. Hymens are often different from person to person. Most women find their hymens
have stretched or torn after their first sexual experience, and the hymen may bleed a little (this
usually causes little, if any, pain). Some women who have had sex don't have much of a change
in their hymens, though.

The vagina connects with the uterus, or womb, at the cervix (which means neck). The cervix has
strong, thick walls. The opening of the cervix is very small (no wider than a straw), which is why
a tampon can never get lost inside a girl's body. During childbirth, the cervix can expand to allow
a baby to pass.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls - in fact,
the uterus contains some of the strongest muscles in the female body. These muscles are able to
expand and contract to accommodate a growing fetus and then help push the baby out during
labor. When a woman isn't pregnant, the uterus is only about 3 inches (7.5 centimeters) long and
2 inches (5 centimeters) wide.

At the upper corners of the uterus, the fallopian tubes connect the uterus to the ovaries. The
ovaries are 2 oval-shaped organs that lie to the upper right and left of the uterus. They produce,
store, and release eggs into the fallopian tubes in the process called ovulation. Each ovary
measures about 1 1/2 to 2 inches (4 to 5 centimeters) in a grown woman.

There are 2 fallopian tubes, each attached to a side of the uterus. The fallopian tubes are about 4
inches (10 centimeters) long and about as wide as a piece of spaghetti. Within each tube is a tiny
passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed
area that looks like a funnel. This fringed area wraps around the ovary but doesn't completely
attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the
fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the
uterus.

The ovaries are also part of the endocrine system because they produce female sex hormones
such as estrogen and progesterone.

Normal Placenta During Childbirth

Process of placental growth and uterine wall changes during pregnancy
1. The placenta grows with the placental site during pregnancy.
2. During pregnancy and early labor the area of the placental site probably changes
little, even during uterine contractions.
3. The semirigid, noncontractile placenta cannot alter its surface area.
Anatomy of the uterine/placental compartment at the time of birth
1. The cotyledons of the maternal surface of the placenta extend into the decidua basalis,
which forms a natural cleavage plane between the placenta and the uterine wall.
2. There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the
branches of the uterine arteries that run through the wall of the uterus to the placental
area.
3. The placental site is usually located on either the anterior or the posterior uterine wall.
4. The amniotic membranes are adhered to the inner wall of the uterus except where the
placenta is located.

PATHOPHYSIOLOGY
DIAGNOSTIC/LABORATORY

Hgb- 
Platelet - ↓

Fibrinogen - ↓

Fibrin degradation products - ↑

Management:

– monitoring of maternal vital signs, fetal heart rate (FHR), uterine contractions and
vaginal bleeding
– likelihood of vaginal delivery depends on the degree and timing of separation in labor
– cesarean delivery indicated for moderate to severe placental separation
– evaluation of maternal laboratory values
– F & E replacement therapy; blood transfusion
– Emotional support

Nursing Interventions:

– Assess the patient’s extent of bleeding and monitor fundal height q 30 mins.
– Draw line at the level of the fundus and check it every 30 mins (if the level of the fundus
increases, suspect abruptio placentae)
– Count the number of pads that the patient uses, weighing them as necessary to determine
the amount of blood loss
– Monitor maternal blood pressure, pulse rate, respirations, central venous pressure, intake
and output and amount of vaginal bleeding q 10 – 15 mins
– Begin electronic fetal monitoring to continuously assess FHR
– Have equipment for emergency cesarean delivery readily available:
-prepare the patient and family members for the possibility of an emergency CS
delivery, the delivery of a premature neonate and the changes to expect in the
postpartum period

-offer emotional support and an honest assessment of the situation

– if vaginal delivery is elected, provide emotional support during labor

-because of the neonate’s prematurity , the mother may not receive an analgesic
during labor and may experience intense pain

-reassure the patient of her progress through labor and keep her informed of the
fetus’ condition

– tactfully discuss the possibility of neonatal death

-tell the mother that the neonate’s survival depends primarily on gestational age,
the amount of blood lost, and associated hypertensive disorders

-assure her that frequent monitoring and prompt management greatly reduce the
risk of death.

– encourage the patient and her family to verbalize their feelings

 – help them to develop effective coping strategies, referring them for counseling if
necessary.

Goals of Care:

1. blood loss is minimized, and lost blood is replaced to prevent ischemic necrosis of distal
organs, including kidneys
2. DIC is prevented or successfully treated.
3. normal reproductive functioning is retained
4. the fetus is safely delivered
5. the woman retains a positive sense of self-esteem and self-worth.

NURSING CARE PLAN

Assessment Diagnosis Planning Interventio Rationale Evaluation

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DRUG STUDY

DRUG ACTION INDICATION SIDE NURSING

NAME EFFECTS CONSIDERATIONS

and &
RESPONSIBILITIES
ADVERSE
EFFECTS

Generic Inducing Oxytocin is a Nausea; Do NOT use Oxytocin

Name: labor in uterine vomiting; if:
women with stimulant. It more
• you are
Rh works by intense or
allergic to any
Oxytocin problems, causing abrupt
ingredient in
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best interest concentration small
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help abort a difficult
the fetus in position within
cases of the womb or is
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produce
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 bleeding for birth
after
• you have
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bacteria in the
blood

DISCHARGE PLANNING

Discharge Plan:

Medication

• Betamethasone (Celestone) is a corticosteroid that acts as an anti-inflammatory and

immunosuppressive agent.

• Assess for contraindications of Betamethasone administration. Obtain reports of urine

and cervical cultures and fibronectin.

Exercise

• Needs to adequate her time with her child to be certain he or she is all right, and nurse
can states hearing fetal heart beat helps to reassure her about baby’s health.

• Attach contraction and fetal heart rate monitoring for continuous evaluation of
contractions of fetal response.

Treatment

• Used of drugs

• Catheterization

Health Teaching

• Maintain a bed rest

• Maintain a 8 glasses of water

Ongoing Assessment
• Assess client’s home surrounding to determine whether they are appropriate for bed rest
and continuing monitoring at home. Administer oral dose and home monitoring requires
professional supervision.

Diet

• She might to begin to neglect her diet or her supplementary vitamins because “It doesn’t
matter anymore”.

Spiritual

• Assess anxiety level of client over preterm labor possible feelings.

• Determine whether client wants a support person to be wit her, to the presence of a
support person can offer additional comfort to a client.

Possible Nursing Diagnosis for Placenta Previa:

• Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation

• Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental
Implantation

• Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation

• Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss

• Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to Potential for
Hemorrhage

• Altered Diversional Activity r/t Inability to Engage in Usual Activities Secondary to

Enforced Bed Rest and Inactivity During Pregnancy