Abruptio Placentae (Placental Abruption) Definition Placental Abruption is the premature separation of a normally implanted placenta from the uterus after 20 weeks of pregnancy and before delivery. It is an obstetric emergency because it decreases oxygen supply to the fetus and can cause severe maternal bleeding. Types Concealed hemorrhage – blood trapped behind placenta Revealed hemorrhage – visible vaginal bleeding Mixed hemorrhage – both concealed and revealed bleeding Risk Factors / Causes Hypertension / preeclampsia Trauma to abdomen Smoking Cocaine or drug abuse Previous abruptio placentae Multiple pregnancy Sudden loss of amniotic fluid Advanced maternal age Pathophysiology Placenta separates from uterine wall → bleeding occurs → decreased maternal-fetal blood exchange → fetal hypoxia and distress → possible fetal death. Signs and Symptoms ( Very Important for NCLEX) Maternal Signs Sudden severe abdominal pain Dark red vaginal bleeding Board-like rigid uterus Uterine tenderness Frequent contractions Signs of shock: Tachycardia Hypotension Cold clammy skin Fetal Signs Fetal distress Decreased fetal movement Abnormal fetal heart rate Possible fetal death Difference Between Placenta Previa and Abruptio Placentae Feature Abruptio Placentae Placenta Previa Bleeding Dark red Bright red Pain Severe pain present Painless Uterus Rigid/board-like Soft Fetal distress Common Less common Diagnostic Evaluation Ultrasound Fetal monitoring (CTG/NST) CBC and hemoglobin Coagulation profile Blood grouping and cross matching Medical Management Oxygen administration IV fluids and blood transfusion Continuous fetal monitoring Emergency cesarean section if severe Monitor maternal vital signs Management Nursing Assessment Assess amount and color of bleeding Monitor fetal heart rate Assess abdominal pain and uterine rigidity Monitor maternal vital signs Observe signs of shock Nursing Interventions Place patient in left lateral position Administer oxygen Maintain IV access Prepare for emergency delivery Monitor intake and output Avoid vaginal examination unless prescribed Provide emotional support Nursing Diagnoses Deficient fluid volume related to blood loss Decreased fetal cardiac output Acute pain related to placental separation Anxiety related to fetal/maternal risk Complications •Maternal Hemorrhagic shock DIC (Disseminated intravascular coagulation) Renal failure •Fetal Prematurity Hypoxia Fetal death NCLEX Important Points Painful bleeding + rigid uterus = Abruptio placentae Painless bright bleeding = Placenta previa Fetal distress is common in abruptio placentae Do NOT delay emergency treatment Easy Memory Trick “PAIN” P → Painful bleeding A → Abdomen rigid I → Increased uterine tone N → Non-reassuring fetal heart rate
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