abruptio placenta

nursing

1. PRESENTATION 0N ABRUPTION PLACENTA SUBJECT :OBSTETRICS & GYNECOLOGY SUBMIITED TO. MRS. SNEHLATA PARASHAR M.Sc LECTURER (OBG & GYN) SUBMITTED DATE. SUBMITTED BY. MISS. RINKU MALI B.SC NURSING IV YEAR

2. INTRODUCTION Placental abruption (also referred to as abruptio placentae) refers to partial or complete placental detachment prior to delivery of the fetus. The diagnosis is typically reserved for pregnancies over 20 weeks of gestation.

3. DEFINITION It is one form of antepartum hemorrhage where the bleeding occurs due to premature separation of normally situated placenta. Out of the various nomenclature, abruptio placentae seems to be appropriate one. A serious pregnancy complication in which the placenta detaches from the womb (uterus). Placental abruption occurs when the placenta detaches from the inner wall of the womb of the delivery. Pre mature separation of a normally situated placenta after 28 weeks gestation & before birth of the bady.

4. TYPES Revealed : Following separation of the placenta, the blood insinuates downwards between the membranes and the decidua. Ultimately, the blood comes out of the cervical canal to be visible externally. This is the commonest type. Revealed

5. 2. Concealed : The blood collects behind the separated placenta or collected in between the membranes and decidua. The collected blood is prevented from coming out of the cervix by the presenting part which presses on the lower segment. At time, the blood may percolate into the amniotic sac after rupturing the membranes. In any of the circumstances blood is not visible outside. This type is rare. Concealed

6. Mixed ( revealed & concealed ) 3. Mixed : IN this type, some part of the blood collects inside (concealed ) and a part is expelled out (revealed ). Usually one variety predominant over the other. This is quite common.

7. ETIOLOGY The causes of abruptio Placentae are unknown, but it is associated with : High birth order pregnancies with gravida 5 and above Spasm of the uterine vessels Pre-eclampsia High parity ( Grande multiparity ) Advancing age of the mother Poor socio-economic condition Malnutrition Smoking ( vaso- spasm) Trauma - External cephalic version Road traffic accidents Needle puncture at amniocentesis

8. PATHOPHYSIOLOGY

9. Clinical manifestations Dark red vaginal bleeding Uterine tenderness Abdominal or back pain Fetal distress Shock greater than blood loss Idiopathic premature labour Diminished urinary output Absent fetal heart sound Increase in size of uterus Failure of the uterus

10. Investigations & Diagnostic findings History taking Physical examination Complete blood cell count Urine analysis Liver function tests Renal function tests Prothrombin time (PTT) Bleeding time (BT) Clotting time (CT) Fibrinogen level Fibrinogen degradation products USG ( Ultrasonography)

11. Normal placenta Placental abruption

12. Complications Maternal complications Hemorrhagic Shock DIC ( disseminated Intravescular coagulation) Uterine rupture Renal failure Ischemic necrosis of distal organs (eg. Hepatic, adrenal, pituitary) Fetal complications Hypoxia Anemia Growth retardation CNS anomalies Fetal death

13. Medical management & treatment 1. Tocolytic agents : Magnesium sulfate Nifidipin Prostaglandin inhibitors : Celecoxib 2. Corticosteroids : Dexamethasone Betamethasone

14. Surgical management Caesarean section: caesarean delivery ( also called a caesarean section or c – section ) is the surgical delivery of a baby by an incision through the mother’s abdomen (belly) and uterus (womb). This procedure is done when it is determined to be a safer method then a vaginal delivery for the mother, baby, or both.

15. Nursing management Assess the condition of the patient. Vital singn‘s such as blood pressure, pluse, respiration, fetal heart sounds are monitored frequently & recorded carefully. The amount of bleeding is to be assessed & noted down. Haematological investigations like blood grouping, cross matching are to be done immediately & blood should be arranged & transfused rapidly. Urinary out put & colour of skin should be observed & recorded.

16. Administer analgesics if she has pain. Provide comfortable position ( left lateral Position ) to prevent vena canal occlusion and compression of aorta by the gravid uterus. Maintain an IV line with 16 gauze intracather to administer plasma expander & blood. Central venous line is inserted to monitor CVP every 2 hourly or more Frequently. Provide emotional support by answering her queries. Relatives should be informed about her Condition and the prognosis to allay anxiety.

17. Fundal height and abdominal girth are measured on hourly basis. Increasing fundal height is indicative of continuous bleeding behind the placenta. Prepartions are done to carry out caesarean section after her condition stablizes. No matter fetus is alive or dead. Administer oxygen to relieve hypoxia. Observe her for any complications, eg. Hypotension, hypovolemia, shock, DIC, renal failure.

18. Conclusion Abruptio Placentae is an important cause of fetal and maternal morbidity and mortality. The etiology is poorly understood , various management options are however available . The principle of initial assessment of the patients condition and subsequent planned management aimed atresuscitation and prolongation of pregnancy if possible or immediate delivery either for fetal or maternal indications.