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ABRUPTIO PLACENTA

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ABRUPTIO PLACENTA Definition: - Premature separation of the placenta from the uterine wall. - Common cause of bleeding during the second half of pregnancy - Usually occurs after 20 to 24 weeks of pregnancy but may occur as late as during first or second stage of labor. Risk factors: - women with parity of 5 or more - women over 30 years of age - women with pre-eclampsia - eclampsia and renal or vascular disease. Factors contributing to ABRUPTIO PLACENTA - multiple gestations - hydramnios - cocai
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    ABRUPTIO PLACENTADefinition:- Premature separation of the placenta from the uterine wall.- Common cause of bleeding during the second half of pregnancy- Usually occurs after 20 to 24 weeks of pregnancy but may occur as late as during first or second stage of labor.Risk factors:- women with parity of 5 or more- women over 30 years of age- women with pre-eclampsia - eclampsia and renal or vascular disease.Factors contributing to ABRUPTIO PLACENTA- multiple gestations- hydramnios- cocaine use- dec. blood flow to the placenta- trauma to the abdomen- dec. serum folic acid levels- PIHCause: UnknownTheories proposed relating it¶s occurrence to dec. blood flow to the placentathrough the sinuses during the last trimester; Excessive intrauterine pressure caused byhydramnios or multiple pregnancy may also be contributing factors.Clinical manifestations:Covert (severe)/ Mild separation/ Mild Abruptio PlacentaThe placenta separates centrally and the blood is trapped between the placenta andthe uterine wall.Signs and Symptoms:1. no overt bleeding from vagina2. rigid abdomen3. acute abdominal pain4. dec. BP5. inc. pulse6. uteroplacental insufficiencyOvert (partial)/ Moderate separation/ Moderate Abruptio PlacentaThe blood passes between the fetal membranes and the uterine wall and escapesvaginally. May develop abruptly or progress from mild to extensive separation withexternal hemorrhage.Signs and Symptoms:  1. vaginal bleeding2. rigid abdomen3. acute abdominal pain4. dec. BP5. inc. pulse6. uteroplacental insufficiencyPlacental Prolapse/ Severe separation/ Severe Abruptio PlacentaMassive vaginal bleeding is seen in the presence of almost total separation withpossible fetal cardiac distress.Signs and Symptoms:1. massive vaginal bleeding2. rigid abdomen3. acute abdominal pain4. shock 5. marked uteroplacental insufficiencyManagement:- monitoring of maternal vital signs, fetal heart rate (FHR), uterine contractions andvaginal bleeding- likelihood of vaginal delivery depends on the degree and timing of separation inlabor - cesarean delivery indicated for moderate to severe placental separation- evaluation of maternal laboratory values- F & E replacement therapy; blood transfusion- Emotional supportNursing 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 thefundus increases, suspect abruptio placentae)- Count the number of pads that the patient uses, weighing them as necessary todetermine 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 anemergency CS delivery, the delivery of a premature neonate and thechanges to expect in the postpartum period-offer emotional support and an honest assessment of the situationif vaginal delivery is elected, provide emotional support during labor -because of the neonate¶s prematurity , the mother may not receive ananalgesic during labor and may experience intense pain-reassure the patient of her progress through labor and keep her informedof the fetus¶ condition  - tactfully discuss the possibility of neonatal death-tell the mother that the neonate¶s survival depends primarily ongestational age, the amount of blood lost, and associated hypertensivedisorders-assure her that frequent monitoring and prompt management greatlyreduce 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 kidneys2. DIC is prevented or successfully treated.3. normal reproductive functioning is retained4. the fetus is safely delivered5. the woman retains a positive sense of self-esteem and self-worth.Additional lab results:Hgb-Platelet -Fibrinogen -Fibrin degradation products -Other possible nursing diagnosis: ‡ Impaired gas exchange: fetal related to insufficient oxygen supply secondary to premature separation of the placenta. ‡ Pain related to bleeding between the uterine wall and the placenta secondary to premature separation of the placenta. ‡ Fear related to perceived or actual grave threat to body integrity secondary to excessive bleeding and threat to fetal survival. ‡ Grieving related to actual or threatened loss of infant.‡ Powerlessness related to maternal condition and hospitalization.‡ Risk for deficient fluid volume related to excessive losses secondary to premature placental separation.Female Reproductive System  Most species have 2 sexes: male and female. Each sex has its own unique reproductivesystem. They are different in shape and structure, but both are specifically designed toproduce, nourish, and transport either the egg or sperm.Unlike the male, the human female has a reproductive system located entirely in thepelvis. The external part of the female reproductive organs is called thevulva, whichmeans covering. Located between the legs, the vulva covers the opening to thevaginaand other reproductive organs located inside the body.The fleshy area located just above the top of the vaginal opening is called them onspubis. Two pairs of skin flaps called the labia (which means lips) surround the vaginalopening. Thecl itoris, a small sensory organ, is located toward the front of the vulvawhere the folds of the labia join. Between the labia are openings to theurethra (the canalthat carries urine from the bladder to the outside of the body) and vagina. Once girlsbecome 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, andovaries.The vagina is a muscular, hollow tube that extends from the vaginal opening to theuterus. 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 aswide as a baby. The vagina's muscular walls are lined with mucous membranes, whichkeep it protected and moist. The vagina serves 3 purposes: It's where the penis is insertedduring sexual intercourse, and it's also the pathway that a baby takes out of a woman'sbody during childbirth, called the birth canal, and it provides the route for the menstrualblood (the period) to leave the body from the uterus.A thin sheet of tissue with 1 or more holes in it called thehym en partially covers theopening of the vagina. Hymens are often different from person to person. Most womenfind their hymens have stretched or torn after their first sexual experience, and the hymenmay bleed a little (this usually causes little, if any, pain). Some women who have had sexdon't have much of a change in their hymens, though.The vagina connects with theuterus, or womb, at thecervix (which means neck). Thecervix has strong, thick walls. The opening of the cervix is very small (no wider than astraw), 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 - infact, the uterus contains some of the strongest muscles in the female body. These musclesare able to expand and contract to accommodate a growing fetus and then help push thebaby 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 theovaries.
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