WHAT IS IT

Detachment of the placenta from the uterine wall before delivery

·        Most at risk of occuring during 3rd trimester

·        Most commonly a few weeks before giving birth

o    Concealed - Blood accumulates behind uterine wall

o    Revealed - Blood leaks out of cervix causing vaginal bleeding

o    PARTIAL ABRUPTION - Placenta partially detaches

o    COMPLETE ABRUPTION - Placenta completely detaches

Role of Placenta: Organ that develops during pregnancy to:

·        Remove waste from baby

·        Deliver nutrients & O2 to baby

·        The placenta usually detaches and is delivered 10-20 minutes following childbirth

RISK FACTORS

·        Chronic hypertension

·        Previous placental abruption

·        High parity (giving birth multiple times)

·        Trauma to abdomen

·        Premature rupture of membranes

·        Advanced maternal age (>35 years old)

·        Smoking or cocaine use

SYMPTOMS

·        CONCEALED BLOOD LOSS: blood pooling inside mother

·        Dark red vaginal bleeding

·        Extended fundal height

·        Hard abdomen

·        Severe continuous abdominal pain

·        Rigid & tender uterus

·        Fetal distress: late decelerations

COMPLICATION: DIC (Medical Emergency)

Placenta detachment triggers clotting cascade, causing severe abnormal clotting & bleeding

·        SYMPTOMS

o    Bleeding gums, oozing at IV sites

o    Petechiae or purpura

o    Chest pain, dyspnea, oliguria

·        TREATMENT

o    Blood products

§  Platelets to bleeding

§  Fresh frozen plasma to t clotting

§  Cryoprecipitate to t fibrinogen

§  RBC to replace blood loss & volume

o    IV fluids

o    Heparin: stop clotting

NURSING INTERVENTIONS

·        Bedrest

·        NO vaginal exams

·        Monitor VS of mother and baby (q15 min)

·        Monitor bleeding

o    Count & weigh pads

o    Monitor fundal height & abdominal girth

·        Left side lying position: maximizes blood flow to baby

·        Labs

o    Type & cross

o    Coags

o    CBC

·        Prepare mother for delivery

o    Vaginal if baby & mom stable

o    C-section if signs of distress

·        Emotional support