07.04 Abruptio Placentae (Placental abruption)

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Overview

  1. When the placenta detaches from the uterine wall prior to delivery
  2. Also called Placental Abruption
  3. Emergency

Nursing Points

General

  1. Can cause massive bleeding
    1. Internal if incomplete separation
      1. Builds up behind placenta
    2. External if complete separation
  2. Decreases perfusion of oxygen and nutrients to the fetus because placenta no longer attached to the mom’s circulation
  3. Medical emergency
  4. Important to be able to distinguish from placenta previa
    1. Previa = painless bleeding
    2. Abruption = Painful!

Assessment

  1. Dark red bleeding
  2. Severe abdominal pain
  3. Uterine rigidity and/or pain
    1. Board-like abdomen
  4. Fetal distress
    1. Bradycardia
  5. Shock symptoms, if extensive blood loss has occurred

Therapeutic Management

  1. Monitor mother and baby
    1. Fetal heart tones and pattern
      1. Decelerations?
    2. Vitals
    3. Abdominal Pain or Rigidity
    4. Vaginal bleeding
    5. Change in fundal height
  2. Administer IVF or blood products
  3. Prepare for delivery
    1. Vaginal if only a partial abruption
    2. Emergent c-section if fetal distress noted
  4. Monitor for severe complications
    1. Disseminated Intravascular Coagulation (DIC)
    2. Postpartum Hemorrhage (PPH)

Nursing Concepts

  1. Clotting
  2. Perfusion
  3. Safety

Patient Education

  1. Notify provider right away for any bleeding or severe abdominal pain

Reference Links

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Video Transcript

In this lesson I will explain abruptio placenta and your role in providing care.

Abruptio placenta is also known as placental abruption. So what does this mean? it is when the placenta detaches from the uterine wall prior to delivery. Remember the placenta is the life line. If we lose that prior to delivery then the fetus loses its oxygen source. So this is an emergency!

Our assessment of this patient is going to be bleeding. An abruption can cause massive bleeding. So the placenta is an organ and it is really attached into the uterus so if it becomes detached it is going to bleed! So bleeding could be internal if incomplete separation because it builds up behind or external if complete separation and the bleeding will ooze out. You can see how in this image there external bleeding or internal where it builds up behind. When this happens there is a decrease in perfusion of oxygen and nutrients to the fetus because placenta can no longer deliver because it loses its source. So there will be late decelerations or fetal bradycardia. This patient with an abruption will have painful bleeding so different than a previa which is painless bleeding. The abdomen can get rigid and board-like as it fills with blood. Maternal shock symptoms could also occur on assessment because of blood loss. Sometimes the abruption is suspected and perhaps the patient is 10 centimeters so if this is the case they might just try to deliver vaginially if they think they can deliver quickly and the baby is doing semi ok. We’ve had patients do that or we a few times have had a patient who comes to the unit for abdominal pain and when they are put on the monitor there is fetal bradycardia and they are immediately delivered in the OR because of a suspected abruption.

Management is going to be a lot of monitoring. We are going to monitor mom’s vitals for shock symptoms. Does she have abdominal pain or rigidity occurring? Or how about any bleeding? If moms abdomen is filling with blood you might notice a change in the fundal height. We monitor the baby for heart tones and pattern. Is there decelerations? This would be late decelerations or bradycardia showing us fetal stress. We need to prepare for delivery. If it is only a partial abruption then they might be able to deliver vaginally depending on how far along she is and how the fetus is tolerating it. Otherwise we go to the OR for a c-section. We need to keep monitoring for severe complications like DIC and postpartum hemorrhage. You can review those lessons for more information on those complications. Our last management piece is to restore the lost volume so administer IV fluids or blood products to restore this volume.

The patient is going to be educated from the beginning of pregnancy that there are days that she just isn’t going to feel well. It is just the nature of the beast. She will feel sick and tired and have no motivation to do anything. We don’t need her to call the office everytime this happens but we do need her to know that if she ever has bleeding or severe abdominal pain then it is really important that she calls for those reasons.

Perfusion and safety are our nursing concepts, Perfusion because if the placenta becomes detached we have a perfusion issue. Safety because we are concerned about the safety of the mom and baby.
Now onto our key points. Abruptio placenta is a a medical emergency. The placenta separates from the uterus before delivery. We can not have that happen! Symptoms are severe abdominal pain, bleeding, and non-reassuring fetal heart tones. And our treatment will be c-section and volume replacement.

Make sure you check out the resources attached to this lesson and compare and contrast the symptoms of this with previa. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A 32-week pregnant client arrives to the emergency department with severe abdominal pain and vaginal bleeding. What condition should the nurse be concerned for?

  • Question 2 of 5

A 40-week pregnant client arrives to the L&D unit in labor. She admits to using cocaine this morning. The nurse knows this places the client at higher risk for which condition?

  • Question 3 of 5

A nurse is caring for a 38-week pregnant client. The client is complaining of severe abdominal pain. What is your priority assessment?

  • Question 4 of 5

A nurse is assessing a pregnant client who is in labor. Which of the following symptoms would be indicative of a possible placental abruption? Select all that apply.

  • Question 5 of 5

A nurse is assessing a postpartum client who delivered via c-section for a placental abruption. What assessment finding would be the MOST concerning?

Module 0 – OB Course Introduction

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