Abruptio placentae is the premature separation of the placenta from the uterus prior to delivery. It is characterized by vaginal bleeding, uterine tenderness, and fetal distress. Risk factors include hypertension, smoking, cocaine use, trauma, and short umbilical cord. Diagnosis is based on clinical symptoms and examination of the placenta after delivery. Treatment depends on severity but may include bed rest, monitoring, blood transfusions, and emergency cesarean section if the mother or baby show signs of distress.

1. Abruptio Placentae
Prepared by: Crisanto T. Layos

2. • Abruptio placenta is the premature
separation of a normally implanted
placenta before the delivery of the baby.
• It is characterized by a triad of symptoms:
vaginal bleeding, uterine hyper tonus, and
fetal distress.

3. CAUSES
• Unknown
• Hypertension
• Preterm premature rupture of membranes
• Smoking
• Cocaine abuse are the most common
associated factors

4. • A short umbilical cord, thrombophilias,
external trauma, fibroids (especially those
located behind the placental implantation
site), severe diabetes or renal disease,
and vena cava compression are other
predisposing factors.

5. Grading System for Abruptions
Grade 0 Less than 10% of the total placental
surface has detached; the patient has no
symptoms; however, a small retroplacental
clot is noted at birth.
Grade I Approximately 10%–20% of the total
placental surface has detached; vaginal
bleeding and mild uterine tenderness are
noted; however, the mother and fetus are in
no distress.
Grade II Approximately 20%–50% of the total
placental surface has detached; the patient
has uterine tenderness and tetany;
bleeding can be concealed or is obvious;
signs of fetal distress are noted; the mother
is not in hypovolemic shock.
Grade III More than 50% of the placental surface has
detached; uterine tetany is severe; bleeding
can be concealed or is obvious; the mother
is in shock and often experiencing
coagulopathy; fetal death occurs.

6. ASSESSMENT

7. HISTORY
• Obtain an obstetric history
• Determine the date of the last menstrual period to cal-culate
the estimated day of delivery and gestational age
of the infant
• Inquire about alcohol, tobacco, and drug usage, and any
trauma or abuse situations during pregnancy
• Ask the patient to describe the onset of bleeding (the
circumstances, amount, and presence of pain)

8. PHYSICAL EXAMINATION
• Assess the amount and character of vaginal bleeding;
blood is often dark red in color, and the amount may
vary, depending on the location of abruption.
• Palpate the uterus; patients complain of uterine
tenderness and abdominal/back pain.
• The fundus is woodlike, and poor resting tone can be
noted.
• With a mild placental separation, contractions are usually
of normal frequency, intensity, and duration.
• If the abruption is more severe, strong, erratic
contractions occur.

9. • Assess for signs of concealed hemorrhage: slight or
absent vaginal bleeding; an increase in fundal height; a
rigid, boardlike abdomen; poor rest- ing tone; constant
abdominal pain; and late decelerations or decreased
variability of the fetal heart rate.
• A vaginal exam should not be done until an ultrasound
is performed to rule out placenta previa.
• Using electronic fetal monitoring, determine the baseline
fetal heart rate and presence or absence of
accelerations, decelerations, and variability.
• At times, persistent uterine hypertonus is noted with an
elevated baseline resting tone of 20 to 25 mm Hg.
• Ask the patient if she feels the fetal movement.

10. • Using electronic fetal monitoring, determine the
baseline fetal heart rate and presence or
absence of accelerations, decelerations, and
variability.
• At times, persistent uterine hypertonus is noted
with an elevated baseline resting tone of 20 to
25 mm Hg.
• Ask the patient if she feels the fetal movement.
Fetal position and presentation can be assessed
by Leopold’s maneuvers.

11. • Assess the contraction status, and view the fetal monitor
strip to note the frequency and duration of contractions.
• Throughout labor, monitor the patient’s bleeding, vital
signs, color, urine output, level of consciousness, uterine
resting tone and contractions, and cervical dilation.
• If placenta previa has been ruled out, perform sterile
vaginal exams to determine the progress of labor.
• Assess the patient’s abdominal girth hourly by placing a
tape measure at the level of the umbili- cus.
• Maintain continuous fetal monitoring.

12. PSYCHOSOCIAL
• Assess the patient’s understanding of the
situation and also the significant other’s
degree of anxiety, coping ability, and
willingness to support the patient.

13. Diagnostic Highlights
General Comments: Abruptio placentae is diagnosed based on the clinical
symptoms, and the diagnosis is confirmed after delivery by examining the
placenta.
Test Normal Result Abnormally with
Condition
Explanation
Pelvic ultrasound Placenta is
visualized in the
fundus of the
uterus
None; ultrasound
is used to rule out
a previa
If the placenta is
in the lower
uterine segment,
a previa (not an
abruption) exists
Other Tests: Complete blood count (CBC); coagulation studies; type and
crossmatch; nonstress test and biophysical profile are done to assess fetal well-being

14. PRIMARY NURSING DIAGNOSIS
• Fluid volume deficit related to blood loss
OUTCOME
• Fluid balance; Hydration; Circulation status
INTERVENTIONS
• Bleeding reduction; Blood product administration;
Intravenous therapy; Shock management

15. PLANNING AND IMPLEMENTATION
Conservative treatment
• Bedrest
• tocolytic (inhibition of uterine contractions) therapy
• constant maternal and fetal surveillance
• If a vaginal delivery is indicated and no regular
contractions are occurring, the physician may choose to
infuse oxytocin cautiously in order to induce the labor.

16. If the patient’s condition is more severe:
• assessments of blood loss, vital signs, and fetal heart
rate pattern and variability are performed.
• Give LR solution IV
• Blood transfusions
• Central venous pressure (CVP)
(A normal CVP of 10 cm H2O is the goal)
• CVP readings may indicate:
fluid volume deficit (low readings)
fluid overload and possible pulmonary edema
(high readings).

17. • If the mother or fetus is in distress - emergency cesarean
section
FETAL DISTRESS
 Flat variability
 Late decelerations
 Bradycardia
 Tachycardia
Management:
• Turn the patient to her left side
• Increase the rate of her IV infusion
• Administer oxygen via face mask
• Notify the physician.

18. If a cesarean section is planned:
 Informed consent is obtained
 Prepare the patient’s abdomen for surgery
 Insert a foley catheter
 Administer preoperative medications as ordered
 Notify the necessary personnel to attend the operation

19. After delivery
monitor the degree of bleeding
perform fundal checks frequently
(fundus should be firm, midline, and at or below
the level of the umbilicus.)
Determine the Rh status of the mother; if the
patient is Rh-negative and the fetus is Rh-positive
with a negative Coombs’test, administer
Rho(D) immune globulin (rhoGAM).

20. Independent
 During prenatal visits, explain the risk factors and the
relationship of alcohol and substance abuse to the
condition.
 Teach the patient to report any signs of abruption, such
as cramping and bleeding.
• If the patient develops abruptio placentae and a vaginal
delivery is chosen as the treatment option, the mother
may not receive analgesics because of the fetus’s
prematurity; regional anesthesia may be considered.
 Keep the patient and the significant others informed of
the progress of labor, as well as the condition of the
mother and fetus.

21.  Offer as many choices as possible to increase the
patient’s sense of control.
 Reassure the significant others that both the fetus and
the mother are being monitored for complications and
that surgical intervention may be indicated.
 Provide the patient and family with an honest
commentary about the risks.
 Discuss the possibility of an emergency cesarean
section or the delivery of a premature infant.
 Answer the patient’s questions honestly about the risk of
a neonatal death.
 If the fetus does not survive, support the patient and
listen to her feelings about the loss.

22. DOCUMENTATION GUIDELINES
• Amount and character of bleeding: Uterine resting tone;
intensity, frequency, and duration of contractions and
uterine irritability
• Response to treatment: Intravenous fluids, blood
transfusion, medications, surgical interventions
• Fetal heart rate baseline, variability, absence or
presence of accelerations or decelerations, bradycardia,
tachycardia

23. MEDICATIONS
 Instruct the patient not to miss a dose of the tocolytic
medication; usually the medication is prescribed for
every 4 hours and is to be taken throughout the day and
night.
 Tell her to expect side effects of palpitations, fast heart
rate, and restlessness.
 Teach the patient to notify the doctor and come to the
hospital immediately if she experiences any bleeding or
contractions.
 Note that being on tocolytic therapy may mask
contractions. Therefore, if she feels any uterine
contractions, she may be developing abruptio placentae

24. POSTPARTUM
• Give the usual postpartum instructions for avoiding
complications.
• Inform the patient that she is at much higher risk of
developing abruptio placentae in subsequent
pregnancies.
• Instruct the patient on how to provide safe care of the
infant.
• If the fetus has not survived, provide a list of referrals to
the patient and significant others to help them manage
their loss.

25. Thank You
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