abruptio placenta

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 factors\risk 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 20 th to 24 th 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

10. 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 .

11. 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

12. 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.

13. 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.

14. 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 .

15. 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 .

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

17. AFTER DELIVERY ABRUPTION PLACENTA

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

19. 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 .

20. SURGICAL MANAGEMENT- 1.LSCS PROCEDURE .

21. 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 .

22. 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 .

23. 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.

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

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

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