nsg

1. MITTAL COLLEGE OF NURSING
PRESENTATION ON
ABRUPTION PLACENTA
SUBJECT :- OBSTETRIC $ GYNECOLOGY
SUBMITTED TO, SUBMITTED BY
MRS SNEHLATA PARASHAR Miss MADHU CHOUDHARY
M.SC LECTURER B.Sc Nursing
(OBG $ GYN) IVth Year
SUBMITTETED
DATE :- 08/04/2019

2. Specific objective
1.To discuss the introduction of A.P.
2.Definition of A.P.
3.To enumarate etiological factorsrisk factors.
4.To discuss the incidence of A.P.
5.To explain about the types of A.P.
6.To discuss the signs and symptoms of A.P.
7.To explain diagnosis and management.

3. INTRODUCTION-
• It is form of ante partum
haemorrhage[APH] it is genital bleeding
during pregnancy after the 20th to 24th
week of pregnancy up to delivery.
• APH is a two types-;
• 1.placenta previa.
• 2.Abruption placenta.

4. DEFINITION
Abruption placenta are defined as
premature separation of a
normally situated placenta after
28 weeks gestation and before
birth of the baby.

5. INCIDENCE
• 1. INCIDENCE -1;150
• 2 HISTORY OF ABRUPTION-5-17%
• 3 SMOKING -90% INCREASE IN RISK
• 4 PRIMI GRAVIDA -1%
• 5 MULTI GRAVIDA-2.5%

6. Abruption placenta =
• D-Dark red bleeding
• E-Extended fundal height .
• T-Tender uterus .
• A-Abdominal pain /contraction .
• C-Concealed bleeding .
• H-Hard abdomen .
• E-Experience DIC.
• D-Distressed baby .

7. AETIOLOGY
• 1.Infection
• 2.Trauma Injury
• 3.Malnutrition
• 4.Somking
• 5.Advancing age of mother
• 6.Poor socio – economic condition
• 7. Folic acid deficiency
• 8. Hypertension
• 9 Cocaine use [risk of up to 10%]

8. RISK FACTORS
• 1. High birth order
• 2. Maternal age;- pregnant women who are
younger than 20 or older than 35 are at greater
risk .
• 3. maternal trauma , such as motor vehicle
accidents , falls, or nosocomial.
• 4. Hypertension.
• 5.Malnutrition , low socio economic status.
• 6. cocaine abuse.

9. PATHOPHYSIOLOGY

11. TYPES OF A.P
• A.P IS three types ;-
• 1. Revealed types
• 2. concealed types
• 3. mixed types
• 1 Revealed types ;- this is commonest type .
Blood expell out throuhg vagina.
• 2 concealed types;- in this type blood collects
behind the seprated placenta .

12. 3 Mixed type;- in this type , some part of the blood
collects inside and some part is expelled out usually
one variety predominates over the other .
TYPES OF A.P

13. ACCORDING TO CLINICAL
• GRADE 0;-
-No signs and symptoms show in A.P.
-Through diagnosis fetal heart rate check.
-Vaginal bleeding absent .
.GRADE 1;- 45% causes.
-less than 15% blood loss in total blood.
-mild separation of the placenta.
-no complication and shock absent.
-F.H.S normal and vaginal bleeding present.

14. GRADE 2 ;
-Moderate separation of the placenta.
-F.H.S rate decrease.
-Total blood loss 25%.
-It is complicated grade.
GRADE 3 ;
-Severe separation of the placenta.
-more than 30% total blood loss.
-Shock condition in women.
-Fetal heart rate absent.
-Fetal death.

15. Sign and symptom=
• 1.painfull vaginal bleeding ,abdominal pain
,uterine irritability is called classical sign and
symptom
2dark vaginal bleeding
• 3.recurrent bleeding
• 4.Urine output usually diminished.
• 5.uterus hard
• 6.anemia.
• 7.shock and back pain .
• 8.uterine tenderness .

16. Diagnosis=
• 1.ultrasonography.
• 2.coagulation profile to rule out diminish
disseminated intravascular coagulation.=
• -clotting time.
• -Bleeding time.
• -Platelet count .
• -Fibrinogen level.
• -prothrombin and partial prothrombin time .
• 3.renal function test .

17. Complication =
• 1. maternal=
• 1. maternal mortality .
• 2.hypovolaemic shock .
• 3. renal failure .
• 4.DIC.
• 5.PPH.
• 6.Complication of massive transfusion.
• 7.sheehans syndrome .

18. AFTER DELIVERY ABRUPTION PLACENTA

19. 2.FETAL=
1.FETAL DEATH.
2.HYPOXIC BRAIN INJURY.
3.IUGR.
4.NEONATAL ANEMIA.
5.CONGENITAL MALFORMATION .

20. MANAGEMENT -
• MEDICAL MANAGEMENT =
• 1.Fluid and blood replacement .
• 2.Oxygen inhalation .
• 3.Analgesic and antibiotic .ex-morphine
• 4.vaginal delivery blood loss are minimal .
• 5.mother condition is stable
• 6.To give beta methasone for fetal lung
maturity .

21. SURGICAL MANAGEMENT-
• 1.LSCS PROCEDURE .

22. NURSING CARE -
• 1.All maternal and fetal vital sign shuold be
frequently and recorded carefully .
• 2.the amount and nature of bleeding to be
assessd and recorded.
• 3.contraction pattern cervical status to be
monitor if the women is the active labor.
• 4.urinary output and skin colour should be
observe and recorded.
• 5. physical comfort and emotional support must
be provided the women must be assisted to rest
in left lateral position .

23. 6.Fundal height and abdominal girth with are to
be measured hourly .
• 7.an increase indicate continued bleeding
behind the placenta.
• 8 FHR is should be monitor continously and
oxygen to be administer to relive hypoxia .
• 9.obervation must be made for any
developing complication such as .hypotension
,hypovolemia ,shock and DIC .
• 10.Avoding in smoking and alcohol .

24. PREVENTION
• Primary prevention =
• 1. to avoid in smoking and alcohol.
• 2.take the prenatal folic acid .
• 3.control high blood pressure .
• 4. reduce risk of trauma .
• 5.to promote safe care environment .
• 6.keep the regular schedule of prenatal
checks .
• 7.to avoid the risk factor and complication.

25. Secondary prevention
• 1.fetal anomalies .
• 2.history of prior preterm labour .
• 3.multiple gestation.
• 4.uterine anomalies .
• 5.series of maternal disease .
• 6.idiopathic .

26. BIBLOIOGRAPHY
1. a textbook of obstetric including
perinatiology at contraception and edition
richa saxsena,D.C DATTA.
2. Textbook of obstetric nursing Dc dutta page
no 113-12
3. Text book of high risk pregnancy of delivery
fourth edition .page no .421-425.

27. THANK YOU