Bleeding: Placenta Abruptio
Definition: Premature separation of placenta from uterine wall.
Incidence: Occurring in approximately 1 in 120 deliveries and more likely to affect multipara women and women older than 35 yr.
Onset: May occur during prenatal or intrapartum period.
Etiology: Unknown; pre-eclampsia and HTN possible causes.
Symptoms: Dark red vaginal bleeding (may be concealed), severe tearing sensation, abdominal and lower back pain, signs of shock.
Grade 0: <10% detachment, mother and fetus asymptomatic, small retroplacental clot noted at birth.
Grade I: 10%-20% detachment, mild bleeding and uterine tenderness, mother and fetus not in distress.
Grade II: 20%-50% detachment, uterine tenderness and tetany, signs of fetal distress noted, but mother not in hypovolemic shock.
Grade III: >50% detachment, severe uterine tenderness and tetany, hemorrhage, shock, and fetal death; coagulopathy (HELLP syndrome) likely to occur.
- Continuous internal fetal monitoring is performed for signs of distress.
- Supplemental oxygen is administered and IV access is established.
- Labs include CBC, coagulation studies, and type and crossmatch.
- Vaginal delivery is permitted if mother and fetus are not in any distress.
- Emergency c-section is performed if mother and fetus are in distress.
- Blood transfusion may be given for excessive hemorrhage.
- If mother and fetus are stable and pregnancy is <28 wk along, mother is discharged home on tocolytic medications (to inhibit uterine contractions).
- Position Pt on left side if fetus is showing signs of distress.
- Vital signs and mother are monitored closely for signs of shock.
- Assess for signs of occult bleeding: rigid, boardlike abdomen; constant abdominal pain; increased fundal height; late decelerations; or decreased variability of FHR.
- Provide Pt and family with literature on placenta abruptio.
- Instruct Pt to notify physician of any cramping or bleeding.
- Explain actions, dosages, side effects, and adverse reactions of meds.