ABRUPTIO PLACENTA

GROUP MEMBERS:
CAJILIG, TREXZY
CANTO, MELANIE
CASCO, JEBSEN
CEZAR, ALYSSA
DAANG, JERICHO
DE LA PENA, SHARLENE
DEL ROSARIO, JASMINE
DELFIN, AUDREY
 TABLE OF CONTENTS

PRETEST QUESTIONS AUDREY DELFIN

CASE SCENARIO MELANIE CANTO
OBJECTIVES SHARLENE DE LA PENA
MINI-LECTURE OF DISEASE JERICHO DAANG
PATHOPHYSIOLOGY TREXZY CAJILIG
LEVELS OF CARE AUDREY DELFIN
PATIENT CORE COMPETENCY MELANIE CANTO
NURSING CARE PLAN JASMINE DEL ROSARIO &

ALYSSA CEZAR

ENABLING COMPETENCY SHARLENE DE LA PENA

ENRICHING COMPETENCY TREXZY CAJILIG
EMPOWERING COMPETENCY JEBSEN CASCO
IMPLICATIONS JERICHO DAANG
BIBLIOGRAPHY JEBSEN CASCO
POST-TEST AUDREY DELFIN

PRETEST QUESTIONS

1. What is the other term for abruptio placenta?

A. Placental Abruption
B. Placenta Accreta
C. Placenta Previa
D. None of the Above
2. What percent of pregnant women would experience placental abruption?
A. 5%
B. 1%
C. 4%
D. 3%

3. What are the signs and symptoms of placental abruption?

A. Vaginal Bleeding
B. Fever
C. Infection
D. Epistaxis

4. What are the Risk factors of having abruption placenta?

A. Pre-eclampsia
B. Chronic hypertension
C. Short umbilical cord
D. All of the above

5. What are the complication of the mother having abruption placenta?

A. Kidney Failure
B. COPD
C. Hypertension
D. Asthma

6. Placental abruption often presents as painful vaginal bleeding. Where is the pain
originating from?
 A. Uterus
B. Ovaries
C. Fallopian tubes
D. Cervix

7. Through what delivery is an abruptio placenta infant delivered?

A. C-section
B. B section
C. NSVD
D. D section

8. Abruptio placenta most commonly occurs in what trimester?

A. Third trimester
B. Second Trimester
C. First trimester
D. Fourth trimester

9. What are the two types of abruptio placentae?

A. Complete and partial
B. Complete and incomplete
C. Incomplete and Burst
D. None of the above

10. Hallmark symptom between Placenta Previa & Abruptio Placenta?

A. Pain
B. Fever
C. Head ache
D. None of the above

Case Scenario
 B.B., a 39 year old woman, gravida 4, para 4, presented with sudden lower

abdominal pain and severe vaginal bleeding at 26 weeks of gestation. She has familial

hypertension from her paternal side. B.B. has a history of drinking alcoholic beverages

and smoking cigarettes since 18 years old. B.B. stated that she had high blood pressure

ever since she was 20 years old. She decided to take herbal medicines like garlic to

improve her blood pressure. She then decided to have a check-up in her barangay

where she was given proper medicine to lower her blood pressure. The barangay health

unit then referred her to IMH.

During her interview, patient stated that last night, while she was watching

television she suddenly saw a moderate amount of bleeding from her vagina and felt a

severe pain on her lower back and abdomen with rapid contractions on her uterus. Then,

upon assessment at the hospital her blood pressure was checked and the doctor found it

to be 90/60 mmHg with a pulse rate of 120 beats per minute, she was advised to be

confined especially when they found out that the baby was already suffering fetal

distress with a fetal heart rate of 100 beats/min. Clinical symptoms and ultrasonography

findings revealed placental abruption. The volume of bleeding was heavy and led to

disseminated intravascular coagulation and hypovolemic shock. The doctor decided that

B.B. needed to undergo surgery and was scheduled for emergency C-Section.

Objectives
General Objective:

After the presentation, the students will be able to obtain knowledge, develop attitudes

towards the care of a patient with abruptio placenta and improve their skills in providing

a holistic and comprehensive plan of nursing care.

Specific Objectives:

Knowledge

1. Define Abruptio Placenta.

2. Discuss the etiology, pathophysiology, clinical manifestations, and medical

treatment of a patient diagnosed with abruptio placenta.

3. Formulate an appropriate plan of care utilizing promotive, preventive, curative,

and rehabilitative factors to clients with abruptio placenta.

Attitudes

1. Identify therapeutic methods in caring for a client with abruptio placenta.

2. Demonstrate commitment in carrying out nursing responsibilities and ethico-

moral principles in the care of patients with abruptio placenta.

Skills

1. Demonstrate communication skills in educating clients with abruptio placenta and

their significant others.

2. Properly assess the signs and symptoms of a patient with abruptio placenta.

3. Enumerate the possible risk factors of abruptio placenta.

Mini-Lecture
 Placental abruption is the early separation of a placenta from the lining of the uterus

before completion of the second stage of labor. It is one of the causes of bleeding during

the second half of pregnancy. Placental abruption is a serious complication of pregnancy

and placed the well-being of both mother and fetus at risk. Placental abruption is also

called abruptio placenta.

A number of factors are associated with its occurrence. Risk factors can be thought

of in 3 groups: health history, past obstetrical events, current pregnancy, and unexpected

trauma. Factors that increase the risk in the health history include smoking, cocaine use,

maternal age over 35, hypertension and placental abruption in a prior pregnancy.

Condition specific to the current pregnancy may precipitate placental abruption are

multiple gestation pregnancies, preeclampsia, sudden uterine decompression and short

umbilical cord. Finally, trauma to the abdomen such as a motor vehicle accident, fall or

violence resulting in a blow to the abdomen may lead to placental abruption.

Placental abruption occurs when the vascular networks connecting the uterine lining

and the maternal side of the placenta are torn away. These vascular structures deliver

oxygen and nutrients to the fetus. Disruption of the vascular network may occur when

the vascular structures are compromised because of hypertension or substance use or

by condition that causes stretching the uterus. Diagnosis of abruptio placenta is by

clinical presentation of vaginal bleeding, blood in amniotic fluid, uterine contractions that

do not relax, and by identification of retro placental clots at delivery. Other signs and

Symptoms include abdominal pain, nausea, thirst, faint feeling and decreased fetal

movements.

Abruptio placenta is a major cause of hemorrhage in the third-trimester. The severe

hemorrhage is responsible for maternal complications like atonic postpartum

hemorrhage, renal failure, disseminated intravascular coagulation and even maternal

death. The premature placental separation and reduced oxygenation is thought to be

responsible for the adverse perinatal outcome.

Classifications of Abruptio Placenta:

 Grade 1. Small amount of vaginal bleeding and some uterine contractions, no

signs of fetal distress or low blood pressure in the mother.

 Grade 2. Mild to moderate amount of bleeding, uterine contractions, the fetal

heart rate may show signs of distress.

 Grade 3. Moderate to severe bleeding or concealed (hidden) bleeding, uterine

contractions that do not relax (called tetany), abdominal pain, low blood pressure,
fetal death.

There is no treatment to stop placental abruption or reattach the placenta. Once

placental abruption is diagnosed, a woman's care depends on the amount of bleeding,

the gestational age, and condition of the fetus. Vaginal delivery may be possible if the

fetus is tolerating labor. If placental abruption is affecting the fetus, then cesarean

delivery may be necessary. Severe blood loss may require a blood transfusion.

Pathophysiology

Predisposing Factors: Precipitating Factors:

-Age: 39 y.o. -Lifestyle (Alcohol consumption

-Familial history of hypertension and smoking)
-Maternal hypertension
Decrease resiliency of blood
vessel at placental bed

Torn or ruptured blood

vessels

Partial separation of placenta

Peripheral portion detached

Mild to moderate vaginal

bleeding

Increase uterine wall

irritability

Progressive separation

Uterine tetany (continuous

contractions) & fetal distress

50% separation & severe

fetal distress

Disseminated Intravascular
Coagulation

Decrease Platelet
 Massive Bleeding

Maternal shock

Emergency Delivery

Levels of Care

Promotive

Educate the parents on what abruptio placenta is, the treatment options, and

potential complications. Educate the mother about how maternal hypertension, maternal

cocaine use, maternal smoking, and folic acid deficiency can increase the risk of

developing abruptio placenta. Caution the mother about not smoking--studies have

shown that smoking places the fetus at a high risk of not only abruptio placentae due to

the decrease in blood flow to the fetus which can lead to vasospasms and the chance of

premature. Educating and encouraging the mother that maintaining adequate levels of

iron is extremely important, for bother her and her baby. Studies have shown that iron

deficiency anemia can increase chances of having a placental abruption. This can be

caused by inflammation that occurs as a result of increased ferritin in the blood--this

inflammation can lead to early separation of the placenta from the uterine wall. You

should call your health care provider immediately if you experience bleeding in your third

trimester. Only your health care provider can make a proper diagnosis for the cause of

late-term bleeding. The outcome of a placental abruption diagnosis is improved with fast

and accurate treatment.

Preventive

 It is not possible to prevent placental abruption directly, but there are certain things

that you could do to reduce the risk factors. For instance, you could quit smoking or

using illegal drugs. Another prevention measure to take would be to follow your

healthcare provider’s suggestion to keep certain medical conditions, like high blood

pressure, under control.

 You should also get immediate medical care if you have had any form of abdominal

trauma to lower your risk of having placental abruption and any other complication.
 Diligently going to your healthcare provider and getting yourself checked
 Don’t smoke or use illegal drugs like cocaine
 Manage your blood pressure
 Getting yourself checked after suffering an impact to the abdominal area

Curative

 Intravenous therapy. Once the woman starts to bleed, the physician would order a

large gauge catheter to replace the fluid losses.

 Oxygen by mask to limit fetal anoxia

 Monitor fetal heart sounds externally and record maternal vital signs every 5 - 15

minutes to establish baseline and observe progress.

 Keep the mother in a lateral, not supine, position to prevent pressure on the vena

cava and additional interference with fetal circulation.

 If vaginal birth does not seem imminent, cesarean birth is the birth method of choice.

 Intravenous administration of fibrinogen or cryoprecipitate (which contain fibrinogen)

can be used to elevate woman‘s fibrinogen level prior to and concurrently with

surgery.

 Avoid performing any vaginal or abdominal examinations to prevent further injury to

the placenta.
 Fibrinogen determination. This test would be taken several times before birth to

detect DIC.

 Hysterectomy. The worst outcome would be for the woman to develop DIC, and to

prevent exsanguinations, hysterectomy must be performed.

Rehabilitative

 Rest

 Go to the doctor if there‘s a bleeding and pain in the abdomen.

 Do not do strenuous activities.

Eleven Key Areas of Responsibility

Patient Care Competencies

1. Safe and Quality Care (Nursing Care Plan included in the back)
2. Communication

Clarifying – Involves offering back to the speaker the essential meaning, as understood

by the listener, of what they have just said. Thereby checking the listener’s

understanding is correct and resolving any areas of confusion or misunderstanding.

Active listening

 A communication technique that requires that the listener fully concentrate,

understand, respond and then remember what is being said.

 Maintaining eye contact and making verbal remarks to clarify and encourage

further communication.

Using therapeutic touch – can give a patient a sort of comfort to client who is in pain

and having a difficult time. Although the nurse may not be able to solve all of the

patient’s problem, touch may let them feel that they are not alone in their struggles.
Offering self – making oneself available suggests interest in the client and a desire to

assist the client.

Making observations - Observations about the appearance, demeanor, or behavior of

patients can help draw attention to areas that might pose a problem for them. Observing

that they look tired may prompt patients to explain why they haven’t been getting much

sleep lately; making an observation that they haven’t been eating much may lead to the

discovery of a new symptom.

3. Health Education

Objectives Content Outline Teaching

Strategies
Following a 1 hour
discussion, the
patient will be able
to:
1. Define what is Abruptio Placenta is an uncommon yet serious Lecture
Abruptio complication of pregnancy. It occurs when the placenta
Placenta partially or completely separates from the inner wall of
the uterus before delivery. This can decrease or block
the baby's supply of oxygen and nutrients and cause
heavy bleeding in the mother.

2. Identify causes Signs and symptoms: Lecture

and presenting  Vaginal bleeding
symptoms of  Abdominal pain
Abruptio  Back pain
Placenta  Uterine tenderness
 Uterine contractions, often coming one
right after another
 Firmness in the uterus or abdomen

Causes
The cause of placental abruption is
unknown but certain predisposing factors
that can increase the risk of placental
abruption include:
  Placental abruption in a previous
pregnancy, unless the abruption was
caused by abdominal trauma,
assuming the trauma isn't repeated in
the current pregnancy
 Chronic high blood pressure
(hypertension)
 High blood pressure during pregnancy,
resulting in preeclampsia or eclampsia
 A fall or other type of blow to the
abdomen
 Smoking
 Cocaine use during pregnancy
 Early rupture of membranes, which
causes leaking amniotic fluid before
the end of pregnancy
 Infection inside of the uterus during
pregnancy (chorioamnionitis)
 Carrying more than one baby
 Being older, especially after age 40.
 A short umbilical cord

3. Name possible Hemoglobin level and fibrinogen level. These Lecture

diagnostic test tests are performed to rule out disseminated
for Abruptio intravascular coagulation.
Placenta

4. Collaboration and Teamwork

Doctor (OB): An obstetrician is a physician who has successfully completed specialized

education and training in the management of pregnancy, labor, and puerperium (the

time-period directly following childbirth). A gynecologists, a physician who has a

successfully completed specialized education and training in the health of the female

reproductive system, including the diagnosis and treatment of disorders and diseases.

Typically, the education and training for both fields occurs concurrently.
Nurse: An OB-GYN nurse is a registered nurse who provides direct care to women, and

sometimes to infants. OB-GYN nurses may work in hospital labor and delivery and post-

partum units, as well as at birthing centers and maternity or outpatient clinics. Their

duties include admitting patients, taking medical histories and assisting physicians

during procedures. They may administer medications, apply fetal monitoring devices or

perform ultrasounds. They may also lead childbirth preparation classes or educate

women individually about sexually transmitted diseases, birth control or prenatal care.

Dietician: Dietitians have gained expertise in food and nutrition, and are committed to

improving the health of their patients and community. They are an integral part of a

holistic, comprehensive, and multidisciplinary approach to patient care. Work in close

coordination with the doctors, clinical and nursing teams to ensure that patients receive

appropriate nutritional support at all times. Patient-focused quality care is the center of

everything for the department of Nutrition and Dietetics.

Enabling Competencies

1. Management of Resources and Environment

A. Continuously evaluate maternal and fetal physiologic status,

particularly:

 Vital Signs
 Bleeding
 Electronic fetal and maternal monitoring tracings
 Signs of shock-rapid pulse pallor cold and most skin decrease in blood

pressure increasing urine output

 Never perform a vaginal or rectal examination or take any action that

would stimulate uterine activity

 B. Assess the need for immediate delivery the client is in active labor

and bleeding cannot be stopped with bed rest. Emergency cesarean

delivery may be indicated.

C. Provide appropriate management.

 On admission place the woman on bed rest in a lateral position to

prevent pressure on the vena cava.

 Insert a large gauge intravenous catheter into a large vein for fluid

replacement
 Monitor the FHR externally and measure maternal vital signs every

5 to 15 minutes. Administer oxygen to the mother by mask.

 Prepare for cesarean section, which is the method of choice for

the birth.

D. Provide client and family teaching

E. Address emotional psychosocial needs. Outcome for the mother

and fetus spends on the extent of the separation amount of fetal

hypoxia and amount of bleeding.

2. Records Management

• Assist client past and current health history.

• Patient’s records must observe confidentially at all times.
• Documentation and records must be written clearly, neatly, appropriately and

completely.
• Document all the things and procedures done to the client.
• Ensure the clients vital signs, intake and output are monitor and recorded.
• Closely monitor the behavioral change happening to the client.
• Confidentiality and privacy of patient’s record must be observed.
• Accurate and complete recordings give legal protection on the nurse, patient,

caregiver, and health care team.

FDAR (FOCUS, DATA, ACTION, RESPONSE):

DATE/TIME FOCUS DATA PROGRESSIVE NOTES

04/07/18 1. Vaginal Action:
Bleeding - Patient reports of - Monitor maternal vital signs.
8:00 AM abdominal pain. -Monitor for presence and
- Facial mask of pain. amount of vaginal bleeding.
- Guarding behavior. - Monitor for increase pain
and abdominal distension and
rigidity.
- Provide comfort measures
like back rubs and deep
breathing.
- Administer analgesic as
prescribed.
Response:
- Patient reports pain was
relieved and bleeding was
controlled.

2. Pain Action:
- Reports of sharp pain on - Administered Celecoxib
the abdominal and back 200mg IV
with a pain scale of 8 out - Encouraged deep
of 10. breathing exercises and
- Facial grimacing relaxation techniques.
- Guarding behavior - Kept patient comfortable
and safe.
- Restless and irritable
Response:
- Patient reports pain was
relieved from 8/10 to 4/10.

Enhancing Competencies
1. Research

Title: Abruptio Placenta: An Analysis of Risk Factors and Perinatal Outcome

Authors: Vinitha Wills, Jacob Abraham & Rajeev A

Published: March 29, 2015

Abstract

Abruptio placenta is an important cause of maternal as well as perinatal morbidity and

mortality. This study is aimed to determine the risk factors and perinatal outcomes of the

abruptio placenta in a tertiary care hospital. A case-control study was conducted in the

Department of Obstetrics and Gynecology and the Neonatology unit at Pushpagiri

Medical College over a period of 2 years. Twenty-four cases of patients presenting with

abruptio placenta and 100 mothers who came in labor without abruptio placenta acting

as controls participated in the study. Early gestational age, preeclampsia,

hypothyroidism, previous cesarean section, multiple pregnancy and history of threatened

abortion were found to be associated with increased risk of abruptio placentae. Placental

abruption was significantly associated with poor perinatal outcomes – such as low birth

weight babies, poor Apgar scores, congenital malformations, and neonatal deaths.

Conclusion

Many variables identified in this study were found to be consistent with known risk

factors in other studies while others were not. This study reinforces that the occurrence

of abruptio placenta is associated with risk factors like early period of gestation,

preeclampsia, hypothyroidism, previous cesareans, threatened abortion and multiple

pregnancy. Abruptio has an adverse impact on maternal and perinatal outcome. Babies

with congenital malformations and poorer outcome were more in abruptio.

 With the increasing incidence of caesarean section, hypothyroidism and

preeclampsia in the present times, a rise in the incidence of the abruptio placenta should

be anticipated. Ideally all women at risk should have regular and frequent antenatal

checkups at a tertiary center where operating facilities, blood transfusion services and

neonatal care are available. Immediate intervention by the obstetrician and active

resuscitation by the neonatologist is the key to improve maternal and perinatal outcome

in women presenting with abruptio placenta.

Abstract

Placental abruption complicates about 1% of pregnancies and is a leading cause of

vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal

mortality and morbidity. The maternal effect of abruption depends primarily on its

severity, whereas its effect on the fetus is determined both by its severity and the

gestational age at which it occurs. Risk factors for abruption include prior abruption,

smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, and

thrombophilia, advanced maternal age, preterm premature rupture of the membranes,

intrauterine infections, and hydramnios. Abruption involving more than 50% of the

placenta is frequently associated with fetal death. The diagnosis of abruption is a clinical

one, and ultrasonography and the Kleihauer-Betke test are of limited value.

The management of abruption should be individualized on a case-by-case basis

depending on the severity of the abruption and the gestational age at which it occurs. In

cases where fetal demise has occurred, vaginal delivery is preferable. Disseminated

intravascular coagulopathy should be managed aggressively. When abruption occurs at

or near term and maternal and fetal status are reassuring, conservative management

with the goal of vaginal delivery may be reasonable. However, in the presence of fetal or

maternal compromise, prompt delivery by cesarean is often indicated. Similarly,

abruption at extremely preterm gestations may be managed conservatively in selected

stable cases, with close monitoring and rapid delivery should deterioration occur. Most

cases of placental abruption cannot be predicted or prevented. However, in some cases,

maternal and infant outcomes can be optimized through attention to the risks and

benefits of conservative management, ongoing evaluation of fetal and maternal well-

being, and through expeditious delivery where appropriate.

2. Quality Improvement

• Hospital staff should always remember that the patient is the most important

person in medical care.

• Waiting time for the services that is provided should be minimized to prevent any

health complications from occurring due to high waiting time, patients may also

become unhappy.
• Patients/patient’s folks should be provided with the right and sufficient information

regarding the medical and administrative aspect of healthcare that they are

receiving.
• There should be effective communication between staff as well as with the

patient/patient’s folks to make sure that everyone involved knows what is

happening.
• The healthcare staffs should be well trained. This could be done by having

refresher training every certain number of months.

• The right equipment should be available to be used.
• The organization should always be looking at new technologies to be used within

the service.
• Collaboration and teamwork with the other health care team in order to meet high

quality performance and support to the patient.

Structure

• Tertiary hospital
 o Emergency Room – In a crisis, the emergency room can serve as a safe

holding environment, a place for acute stabilization, emergency sedation,

medical and psychiatric evaluation, and disposition for further treatment.

o Pharmacy Department – It is responsible for providing the patient with the

right medication as prescribed by the doctor or physician.

o Laboratory Department – Responsible for quantitative and qualitative

analysis and interpretation of patient specimens.

o Dietary Department – this is fairly important especially with disorders

which require the patient to have a special diet.

o Medical Social Work Department – provides supportive services to

patients, families, and those affected by illness and hospitalization by

offering services such as counseling, providing access to services such

as community supports and respite care, and discharge planning to

assure proper transition from the hospital back to the community setting.
• There should be sufficient fire exits in case of emergency and these exits should

be well labeled.
• The buildings should have a sufficient ventilation system to make sure that there

is clean air flowing through throughout and there is a constant movement of it.
• The practice of the service should be evidence based as to make it more reliable
• The capacity of the building should be able to accommodate a sufficient amount

of people especially during emergencies

• There should be security in place to help and calm clients when required
• Each department or units should have clear signs leading to them to save time

for clients when going around

• There should be emergency equipment such as generators to allow staff to keep

on working during a power outage.

Process

• Provide careful and frequent assessment of physical status, and signs of any

complications.
 o Assess the patient’s history – Checked by staff at the start to guide them on what

is the priority thing to do with the patient’s manifesting symptoms.

• Pharmacologic Management

Outcome

• Patient and family members are well informed regarding the status/condition of the

patient.
• Have a strategy in place for the patient to help manage the illness, this could be in

the form of medications and therapies.

• Prevent any problems within work or other public domains by having periodic

assessment of their mental health and ability to perform tasks.

Empowering Competencies

1. Ethico-Moral Responsibilities

• Non-maleficence: Non-maleficence is the principle of “doing no harm”. This ethical

principle obligates the nurse as well as the other members of the health care team to

maintain competence in patient care thus ensuring the safety and preventing any

injury to the client.

• Veracity: Veracity is the act of telling the truth. This is the duty of the nurse to be

truthful to the client and to the folks which is necessary to build a trusting relationship

with them. Clinical Application: It is the responsibility of the nurse to answer the

questions of the patient and folks regarding the treatment to be done in order to

manage his condition and by this the nurse can establish rapport to the patient.

 Autonomy: Autonomy is a moral principle which is the right of the client to self-

determination and self-direct, specifically in making independent and responsible

 decisions in pertaining to his/her health care. Autonomy obligates the nurses as well

as other members of the health care team to respect the client’s decisions after

thoroughly explaining the advantages and disadvantages of the treatment to be

done.

Clinical Application: The family of the patient has the right to decide whether they want

their son to be treated or not.

 Justice: Justice is giving a person what he/she deserves. In a nursing care setting, the

benefits and burdens should be distributed equally or at least equitably so that

everyone gets to benefit from the health care system and that no one bear too much

of a burden.
 Confidentiality: Confidentiality asserts the obligation of the nurse and other members

of the health care team in keeping all the information, the treatments done, condition

and identification of the patient considering it confidential in order to maintain client’s

privacy. The pertained information shall only be disclosed to those who are directly

involved in the patient care.

Clinical Application: The nurse should not talk with anyone else about the patient’s

condition.

2. Legal Responsibilities
• Presidential Decree No. 603

Sec. 9, Article II of the New Constitution, the State shall among other policies, afford

protection to labor, promote full employment and equality in employment, ensure equal

work opportunities regardless of sex, race, or creed, and regulate the relations between

workers and employers.

 Presidential Decree 651: All births and deaths must be registered 30 days after

delivery.
Section 1. Registration of births. All babies born in hospitals, maternity clinics, private

homes, or elsewhere within the period starting from January 1, 1974 up to the date when

this decree becomes effective, irrespective of the nationality, race, culture, religion or

belief of their parents, whether the mother is a permanent resident or transient in the

Philippines, and whose births have not yet been registered must be reported for

registration in the office of the local civil registrar of the place of birth by the physician,

nurse, midwife, hilot, or hospital or clinic administrator who attended the birth or in

default thereof, by either parent or a responsible member of the family or a relative, or

any person who has knowledge of the birth of the individual child.

3. Personal & Professional Development

 The nurse must have the initiative to attend certain programs and, seminars, and

trainings to enhance understanding of the Abruptio Placenta.

 Read journals for latest updates about intervention and management of Abruptio

Placenta.
 Attend conferences and updates of the DOH to gain knowledge and insight into

new treatment modalities and interventions related to Abruptio Placenta.

Providing patient-centered care of patients as well as exercising respect for the

dignity of the patient is best learned through developing good nurse-patient

relationship.
 The nurse must allow feedback to improve the delivery of her care and to be

more competent. Support from family and friends are beneficial in improving and

promoting personal and professional development.

Implications /Insights/Lessons learned

Nursing Education - This case is significant to nursing educators, as they are the first

line source of knowledge to the students concerning this case. They guide student
nurses on how to take care a patient with Abruptio Placenta. Student nurses then take

the knowledge they have gained from the lectures and apply it in an actual reality in their

clinical assignments. This mold a student nurse to be a competent nurse. Without

nursing educators, student nurses would be unprepared for their exposure to this kind of

case to the area.

Nursing Practice - This case is significant to nursing practice because staff nurses

depend greatly on the previous knowledge similarly to the case they had been as a

guide in rendering care with laboring mothers with Abruptio Placenta. Patients may

present different or same signs; thus, nurse must be prepared to render quality care

needed for each patient is unique. They must be prepared in all aspect of care, to give

the best that they can do in patients with these cases.

Nursing Management - This case is significant to nursing management because a vital

role is also upheld by the nurses during this situation. Their accurate assessment would

be one of the baseline data for all health care providers to plot the care plan for the

patient.

POST-TEST QUESTIONS
1. A 39 year old at 37 weeks gestation is admitted to the hospital with complaints of
vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is
most likely causing the client’s complaint of vaginal bleeding?

a. Placenta Previa

b. Abruptio placentae

c. Ectopic pregnancy

d. Spontaneous abortion
2. A pregnant woman arrives at the emergency department (ED) with abruption
placentae at 34 weeks’ gestation. She’s at risk for which of the following blood
dyscrasias?

a. Thrombocytopenia

b. Idiopathic thrombocytopenic purpura (ITP)

c. Disseminated intravascular coagulation (DIC)

d. Heparin-associated thrombosis and thrombocytopenia (HATT)

3. A maternity nurse is caring for a client with abruptio placentae and is monitoring the
client for disseminated intravascular coagulopathy. Which assessment finding is least
likely to be associated with disseminated intravascular coagulation?

a. Swelling of the calf in one leg

b. Prolonged clotting times

c. Decreased platelet count

d. Petechiae, oozing from injection sites, and hematoma

4. An ultrasound is performed on a client at term gestation that is experiencing moderate

vaginal bleeding. The results of the ultrasound indicate that an abruptio placentae is
present. Based on these findings, the nurse would prepare for the client:

a. Complete bed rest for the remainder of the pregnancy

b. Delivery of the fetus

c. Strict monitoring of intake and output

d. The need for weekly monitoring of coagulation studies until the time at delivery

5. A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was
admitted to the maternity unit with a suspected diagnosis of abruptio placentae.
Which of the following assessment findings would the nurse expect to note if this
condition is present?

a. Absence of abdominal pain

b. A soft abdomen
 c. Uterine tenderness/pain

d. Painless, bright red vaginal bleeding

6. Which of the following would the nurse assess in a client experiencing abruptio
placenta?

a. Bright red, painless vaginal bleeding

b. Concealed or external dark red bleeding

c. Palpable fetal outline

d. Soft and non-tender abdomen

7. Which of the following increases the risk of placental abruption?

a. Age <35 years

b. Gestational diabetes

c. Previous placental abruption

d. Strenuous exercise

8. All of the following can cause Disseminated intravascular coagulation (DIC) during
pregnancy except;

a. Diabetes mellitus

b. Amniotic fluid embolism

c. Intrauterine death

d. Abruptio placentae

9. The following is always an indication of Cesarean section, except:

a. Abruptio Placentae

b. Untreated stage of Ca cervix

c. Active primary genital herpes

 d. Type IV Placenta Previa

10. Which of the following is the most common cause of clinically significant consumptive
coagulopathy?

a. Placenta Previa

b. Abruptio placenta

c. Rupture uterus

d. All of the above

Bibliography

 “Placental abruption”. Mayo Clinic, January 12, 2018. July 11, 2018.

<https://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-

causes/syc-20376458>
 “Abruptio Placentae: When the Placenta Separates Prematurely”. Nurseslabs,

January 18, 2017. July 11, 2018. < https://nurseslabs.com/abruptio-placentae/>.

 “Abruptio Placenta”. SpringerLink, January 01, 1970. July 11, 2018. <

https://link.springer.com/chapter/10.1007/978-3-319-48732-8_3>.

 Hockenberry, Wilson, Perry, & Wong. (n.d.). Maternal Child Nursing (3rd ed., Vol.

1). Mosby.