Real Time Authenticated Information About Abruptio Placenta in Pregnancy
An abruption placenta is the premature separation of the normally implanted placenta in the third trimester. There are two kinds of abruption placenta: concealed hemorrhage and external hemorrhage. With the concealed hemorrhage, the placenta separates centrally, and a large amount of blood is accumulated under the placenta. When an external hemorrhage is present, the separation is along the placental margin, and blood flows under the membranes through the cervix.
Women at risk for developing abruption placenta include those with history of hypertension or previous abruption placenta, abdominal trauma during pregnancy, anomaly of the umbilical cord, uterine fibroids, advanced maternal age, cigarette smoking, and cocaine abuse.
Complications include maternal shock, disseminated intravascular coagulation, anaphylactic syndrome of pregnancy, postpartum hemorrhage, prematurity, maternal, or fetal death, adult respiratory distress syndrome, Sheehan’s syndrome, renal tubular necrosis, and rapid labor and delivery.
Concealed hemorrhage results in change in maternal vital signs, but no visible bleeding is present. External hemorrhage, vaginal bleeding is evident along with a change in maternal vital signs. Fetal heart rate may change, depending on the degree of hemorrhage, tachycardia, late decelerations, and decreased variability. Abdominal pain is usually present and also with nausea and vomiting. There’s a rapid progression of labor.
What are the diagnostic evaluations for Abruptio Placenta?
. Diagnosis is made based on clinical guidelines and clinical signs or symptoms
. Ultrasound is done to exclude placenta previa, but it is not always sensitive enough to pick up abruption placenta
. Laboratory screen for erythrocyte rosette test on mother’s blood to check for fetal cells in maternal circulation
What is the collaborative management for Abruptio Placenta?
. Hospitalization, bed rest and continuous fetal monitoring
. Management of hemorrhagic shock with intravenous fluids and blood transfusions
. Provide information to the woman and her family regarding cause of and treatment for abruptio placenta
. Encourage involvement from neonatal team regarding education related to fetal or neonatal outcome
. Monitor the amount of bleeding by weighing all pads and the presence or absence of pain
. Monitor maternal vital signs and fetal heart through continuous external fetal monitoring
. Monitor the maternal contractions
. Measure and record fundal height, which may increase with concealed bleeding
. Monitor hemoglobin and hematocrit for loss of blood
What are the supportive cares for abruptio placenta?
. Encourage relaxation techniques such as imagery and deep breathing exercises
. Inform the woman and her family about the status of the birth, herself and the fetus
. Encourage the presence of a support person
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