Abruptio placenta including nursing management.

ABRUPTIO PLACENTA

1. AKSHAYA R NAIR

2. AKSHAYA R NAIR

3. DEFINITION IT IS ONE OF ANTEPARTUM HEMORRHAGE WHERE THE BLEEDING OCCURS DUE TO PREMATURE SEPARATION OF NORMALLY SITUATED PLACENTA .

4. INCIDENCE&SIGNIFICANCE ABOUT 1 IN 200 DELIVERIES PERINATAL MORTALITY(15 TO 20%) MATERNAL MORTALITY(2 TO 5%)

5. REVEALED THE BLOOD INSINUATES DOWNWARD THE MEMBRANES AND DESIDUA.THE BLOOD COMES OUT THE CERVICAL CANAL TO BE VISIBLE EXTERNALLY .

6. CONCEALED THE BLOOD COLLECT BEHIND THE SEPERATED PLACENTA OR COLLECTED IN BETWEEN THE MEMBRANES.THE COLLECTED BLOOD IS PREVENTED FROM COMING OUT THE CERVIX BY PRESENTING PARTS ON LOWER SEGMENT.

7. MIXED SOME PARTS OF THE BLOOD COLLECTS INSIDE(CONCEALED) AND A PART IS EXPELLED OUT (REVEALED).

8. ETIOLOGY

9. 1.HIGH BIRTH ORDER PREGNANCY WITH GRAVIDA 5 OR MORE

10. 2.ADVANCING AGE

11. 3.HYPERTENSION SPASAM OF THE VESSELS IN THE UTERO PLACENTAL BED,REPTURE OF THE VESSELS ,FORMATION OF RETRO PLACENTAL HEMATOMA

12. 4.SHORT CORD EITHER RELATIVE OR ABSOLUTE,CAN BRING ABOUT PLACENTAL SEPARATION DURING LABOUR BY MECHANICAL PULL.

13. 5.TRAUMA TRAUMA CAN OCCURS DUE TO EXTERNAL CEPHALIC VERSION, RTA,NEEDILE PUNCTURE AT AMNIOCENTESIS

14. 6.SUDDEN UTERINE DECOMPRESSION DIMINISHED THE SURFACE AREA OF THE UTERUS ADJACENT TO PLACENTAL ATTACHMENT AND RESULT IN SEPARATION

15. 7.TORSION OF UTRES INCREASED VENOUS PRESSURE AND REPTURE OF THE VEINS WITH SEPERATION OF PLACENTA

16. 8.UTRINE FACTOR PLACENTA IS IMPLANTED OVER A SEPTAM OR ASUBMUCOUS FIBROID

17. COUVELAIRE UTERS

18. CLINICAL FEATURES

19. PARAMETERS REVEALED MIXED SYMPTOMS ABDOMINAL DISCOMFORT OR PAIN FOLLOWED BY VAGINAL BLEEDING(SLIGHT) ABDOMINAL ACUTE INTENSE PAIN FOLLOWED BY SLIGHT VAGINAL BLEEDING THE PAIN BECOME CONTINUOS BLEEDING CONTINOUS DARK COLOUR (SLIGHT TO MODERATE) CONTINOUS DARK COLOUR OR BLOOD STAINED SEROUS DISCHARGE GENERAL CONDITION PROPORTIONATE TO THE VISIBLE BLOOD LOSS,SHOCK IS USUALLY ABSENT SHOCK MAY BE PRONOUNCED WHICH IS OUT OF PROPORTION TO THE VISIBLE BLOOD LOSS PALLLOR RELATED WITH VISIBLE BLOOD LOSS SEVERE AND OUT OF PROPORTION TO THE VISIBLE BLEEDING FEATURES OF PREECLAMPSIA ABSENT FREQUENT ASSOCIATION

20. F UTERINE FEEL NORMAL FEEL WITH LOCOLIZED TENDERNES,CONTRACTIONS UTERUS IS TENSE, TENDER &RIGID UTERINE HEIGHT PROPORTIONATE TO GESTATIONAL AGE MAY BE DIS PROPORTIONATE ,ENLARGED, GLOBULAR FETAL PARTS CAN BE IDENTIFIED EASILLY DIFFICULT TO MAKE OUT FHS USUALLY PRESENT USUALLY ABSENT URINE OUT PUT NORMAL DIMINISHED

21. DIAGNOSIS MAINLY CLINICAL,ULTR SONOGRAPHY,MRI

22. LABORATORY TEST REVEALED MIXED BLOOD Hb LOW VALUE ,PROPORTIONATE TO THE BLOOD LOSS MARKEDLY ,LOWER ,OUT OF PROPORTION TO THE VISIBLE BLOOD LOSS Coagulation profile Usually unchanged Variable changes: CLOTTING TIME INCREASED(>6MIN) FIBRINOGEN LEVAL –LOW(<150mg/Dl) PLATLET COUNT LOW URINE FOR PROTEIN MAY BE ABSENT USUALLY PRESENT

23. MANAGEMENT PREVENTION 1 . Prevention of known factors Early detection and effective therapy Needle puncture Avoidance of trauma To avoid supine hypotension routine administration of folic acid

24. TREATMENT ASSESSMENT AMOUNT OF BLOOD LOSS MATURITY OF THE FETUS WHEATHER THE PATIENT IS IN LABOUR OR NOT PRESENCE OF ANY COMPLICATION TYPE AND GRADE OF ABRUPTION

25. EMERGENCY MEASURES BLOOD (HB,COAGULATION PROFILE) RINGER’S SOLUTION DRIP IS STARTED MANAGEMENT OPTIONS ARE: IMMEDIATE DELIVERY MANAGEMENT OF COMPLICATION EXPECTANT MANAGEMENT

26. IMMEDIATE DELIVERY THE PATIENT IN LABOUR LABOUR IS ACCELERATED BY LOW RUPTURE OF THE MEMBRAES,OXYTOCIN DRIP MAY BE STARTED TO ACCELERATE LABOUR VAGINAL DELIVEY IS FAVORED IN CASE WITH LIMITED PLACENTAL ABRUPTION FHR REASSURING PLACENTAL ABRUPTION WITH DEAD FETUS THE PATIENT NOT IN LABOUR INDUCTION OF THE LABOUR CESAREAN SECTION

27. INDUCTION OF THE LABOUR LABOUR IS QUICKELY COMPLETED (4-8HOURS) RETRO PLACENTAL CLOT IS EXPELLED SIMULTANEOUSLY WITH DELIVERY OF BABY Inj.OXYTOCIN 10.IU IV(SLOW),OR Inj.METHERGINE 0.2 Mg IV GIVE ….P b ) CESAREAN SECTION INDICATIONS ARE;- SEVERE ABRUPTION WITH LIVE FETUS,AMNIONECTOMY COULD NOT BE DONE ,AMNIONECTOMY FAIL TO CONTOROL BLEEDING,

28. EXPECTANT MANAGEMENT BLEEDING IS SLIGHT AND STOPPED, THE GOAL OF THE EXPECTANT MANAGEMENT IS PROLONG THE PREGNANCY WITH HOPE OF IMPROVING MATURITY AND SURVIVAL. PATIENT SHOULD BE MONITER IN THE LABOUR WARD FOR 24-48 Hrs to. FURTHER SEPARATION OF THE PLACENTA MAY CAUSE FETAL DEATH AND MATERNAL COMPLICATION..

29. NURSING DIAGNOSIS ACUTE PAIN RELATED TO UTERINE CONTRACTION AS EVIDENCED BY PAIN SCALE SCORE ,VERBALIZATION FLUID VOLUME DEFICIT RELETED TO EXESSIVE VASCULAR LOSS SECONDARY TO BLEEDING AS EVIDENCED BY HYPOTENSION,SHOCK INEFFECTIVE UTERO PLACENTAL TISSUE PERFUSION RELATED TO ABRUPTIO PLACENTA AS EVIDENCED BY CHANGE IN FETAL HEART RATE RISK FOR ANEMIA RELATED TO BLEEDING RISK FOR INTRA UTERINE INFECTION RELATED VAGINAL BLEEDING RISK FOR FETAL HYPOXIA RELATED TO PLACENTAL INSUFFIENCY

30. ACUTE PAIN RELATED TO UTERINE CONTRACTION AS EVIDENCED BY PAIN SCALE SCORE ,VERBALIZATION DETERMINE THE NATURE,SEVERITY,LOCATION AND DURATION OF THE PAIN. ASSESS FOR UTERINE CONTRACTIONS, RETROPLACENTAL HEMORRHAGE OR ABDOMINAL TENDERNESS ASSESS THE PSYCHOLOGICL STRESS AND EMOTION RESPONSE TO EVENT PROVIDE QUIT ENVIRONMENT AND DIVERTIONAL ACTIVITIES ADMINISTER PRESCRIBED NARCOTICS OR SEDATIVES

31. FLUID VOLUME DEFICIT RELETED TO EXESSIVE VASCULAR LOSS SECONDARY TO BLEEDING AS EVIDENCED BY HYPOTENSION,SHOCK REPORT AND RECORD AMOUNT ND THE NATURE OF THE BLOOD LOSS INSTRUCT THE PATIENT TO TAKE STRICT BED REST NOTE VITAL SIGNS MONITER UTERINE ACTIVITY,FETAL STATUS,AND ABNORMAL TENDRNESS RECORD INTAKE OUTPUT ADMINISTER IV SOLUTIONS INCLUDING PLASMA EXPANDERS,WHOLE BLOOD AS PER DOCTORS ORDER AVOID RECTAL OR VAGIAL EXAMINATIONS

32. INEFFECTIVE UTERO PLACENTAL TISSUE PERFUSION RELATED TO ABRUPTIO PLACENTA AS EVIDENCED BY CHANGE IN FETAL HEART RATE NOTE MATERNAL PHYSIOLOGIC STATUS AND BLOOD VOLUME AUSCULTATE AND REPORT FHS RECORD MATERNAL BLOOD LOSS AND ANY UTERINE CONTRACTIONS NOTE EXPECTED DATE OF DELIVERY AND FUNDL HEIGHT ENCOURAGE BED REST IN LATERAL POSITION ADMINISTER SUPPLEMENTAL OXYGEN TO CLIENT

33. RISK FOR FETAL HYPOXIA RELATED TO PLACENTAL INSUFFIENCY ASSESS THE FHR ASESS THE FETAL MOVEMENT ASESS THE MATERNAL BLOOD LOSS

34. BY AKSHAYA R NAIR