Nursing Care Plan for Abruptio Placentae / Placental abruption

Pathophysiology

Abruptio placentae, or placental abruption, is when the placenta partially or completely detaches prematurely from the uterus, causing a risk for hemorrhage. This is most often seen at 24-26 weeks gestation and is considered a serious complication. In mild cases, the patient may remain on restricted activity or bed rest for the duration of the pregnancy, but in more severe cases where there is maternal or fetal compromise, delivery is required. While placental abruption generally happens suddenly, chronic abruption may occur in which there is a small separation that causes slow bleeding behind the placenta.

Etiology

Etiology is generally unknown, but risk factors include abdominal trauma, vascular disorders, hypertension (chronic or gestational), PROM or other rapid loss of amniotic fluid, infection, prior history of placental abruption, advanced maternal age (>35 yrs old)  and maternal use of tobacco or cocaine. Complications of abruptio placentae include fetal growth restriction, distress or death, maternal blood loss and shock, blood clotting issues (DIC) and maternal kidney and organ failure.

Desired Outome

Patient will have no or minimal bleeding; pain will be controlled, fetus will show no signs of distress

Abruptio Placentae / Placental abruption Nursing Care Plan

Subjective Data:

  • Abdominal pain
  • Uterine tenderness
  • Back pain
  • Constant uterine contractions

Objective Data:

  • Vaginal bleeding
  • Back to back uterine contractions
  • Firmness of uterus on palpation

Advanced abruption and severe blood loss may lead to shock

  • Tachycardia
  • Hypotension

Nursing Interventions and Rationales:

  1. Assess and monitor vaginal bleeding
    • Excessive bleeding may result in shock. Amount of obvious blood may not fully indicate severity due to possible internal bleeding
  2. Obtain history from patient
    • Determine time bleeding began, any history of pregnancy complications or abdominal/uterine trauma
  3. Place patient on bed rest in lateral position
    • This position helps avoid pressure on the vena cava to avoid decreased cardiac output
  4. Initiate IV access with large bore line
    • IV fluids will be given to manage hypovolemia and blood transfusion may be required
  5. Assess abdomen for uterine tenderness and contractions
    • Uterus may be tender upon palpation, tense and rigid.

      Fundal massage may help to slow bleeding from uterine wall.
  6. Monitor maternal vitals for signs of shock
    • Watch for signs of hypovolemia to include tachycardia, tachypnea and hypotension
  7. Place and observe external fetal monitoring for signs of fetal distress
    • This allows you to monitor fetal heart rate and contractions to observe for variability and responsiveness of the fetal heart rate. A lack of variability or decelerations indicate fetal distress.
  8. Assess and manage pain: Massage, Guided imagery, Cool compresses to the forehead, Deep breathing techniques
    • Abdominal, back and uterine pain may accompany bleeding and at times may be severe, especially with contractions.

      Provide alternative options for pain relief if able
  9. Administer medications: Corticosteroids, Analgesics as appropriate, Oxytocin
    • In addition to IV fluids, corticosteroids may be given to speed up fetal lung development if delivery is necessary.

      Oxytocin may be given after delivery to decrease hemorrhage.
  10. Provide patient education
    • Help patient to feel more informed and lessen anxiety and stress

References

Date Published - Nov 14, 2018
Date Modified - Nov 14, 2018