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Nursing Knowledge
Placental abruption, also referred to as abruptio placentae, is a premature separation of the placenta from the uterine wall before completion of second-stage labor.
This obstetric emergency compromises fetal oxygen supply, prompting fetal distress and possible death. Bleeding from the placental site can lead to shock, disseminated intravascular coagulation (DIC), and possible death for the client without prompt intervention.
Placental abruption occurs due to compromise to the vascular structures that support the placenta and connect it to the uterine lining. This vascular compromise may occur due to:
Symptoms may range from mild to severe based on the extent of abruption.
The pregnant client presents with sudden uterine pain and sustained uterine contraction/rigid abdomen. Bleeding could be present or absent. If bleeding is severe, there could be vital sign alterations and clotting profile alterations (hypofibrinogenemia, coagulopathy).
In the fetus, placental abruption presents with decreased fetal movement and FHR, late decelerations, and sustained bradycardia.
Both of these conditions are obstetric emergencies that can be life-threatening to the pregnant client and the fetus, and both are related to the position/location of the placenta.
The key differences lie in the symptoms, causes, and interventions:
Table: Placenta previa vs placental abruption
| Placenta previa | Placental abruption | |
| Definition + causes | Placenta located low, covering cervical os | Placenta detaching from uterine wall before delivery |
| Presentation | Painless bleeding in 3rd trimester | Painful bleeding and contractions |
| Management | Pelvic rest and potentially cesarean delivery | Hospitalization; can require immediate delivery |
Potential important nursing diagnoses related to placental abruption include:
The main nursing tasks when caring for a client with placental abruptions include:
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