Iloilo Doctors’ College
College of Nursing
Care of Mother & Child At Risk or with Problems (Acute & Chronic)
NCM 109 RLE
Case Scenario #3: Abruptio Placenta
A case of patient E.Q. 40 year old married a factory worker. She is 36 weeks pregnant with her
first baby. Came in the hospital at around 3:20 a.m. with a chief complaints of moderate
bleeding, with mild to moderate uterine contractions. Three weeks prior to admission, the
patient manifest mild uterine contraction with vaginal spotting. She sought consultation and
was given Duvadilan 10 mg every 6 hours and was advice bed rest without bathroom privileges.
An hour prior to admission a patient experienced mild to moderate vaginal bleeding with
moderate uterine contraction. Physical assessment shows that patient is pale, poor skin turgor
Temp. 37°C; PR: 88 bpm; RR: 16cpm and BP 120/80 mmHg, LMP: 10/07/19, EDC: 07/14/20.
Abdominal Ultrasound requested and revealed a live fetus, the placenta was attached to the
anterior uterine wall, but with a suggestive separation and rounding of the placental edge.
Upon auscultation the heartbeat of the baby is 100 beats/min. The doctor suggested a Stat
caesarean section, her husband was appraised of her status. A diagnosis of Abruption Placenta
based on clinical symptoms and ultrasonographic findings.
She used to drink caffeine beverages and have fun eating junk foods, noodles for breakfast and
snacks in her workplace. She is a known smoker at the age of 20 and consumed 6-7 sticks a
day and stopped when she got pregnant. Her mother is a known hypertensive and diabetic.
The patient OB score is G1T1P0A0L1. She has a regular prenatal check up in Lying in Clinic.
Laboratory findings: Hemoglobin 7.9 g/dl, Hct 29%, Platelet count 82,000/L, Prothrombin time
11.2 seconds, Na 146.5, K 3.85, Chloride 107.5, RBC 5.6 million/mm3, Urinalysis positive RBC.
Venoclysis started 0.9% NaCl to run for 15gtts/minute; transfuse 2 units of PRBC after
crossmatch. Insert indwelling catheter attached to urinary bag as ordered. At 4:30 am patient
E.Q. wheeled into the Operating Room for Caesarean Section. At exactly 5 o’clock in the
morning she delivered a live baby boy weighing 2400g via Low Segment Transverse Caesarean
Section (LSTCS), Post op orders: Ketorolac Tromethamine 30mg IVTT every 6 hours for 3 days
then shift to oral Mefenamic acid 500mg 1tablet every 6 hours prn for pain; Cefuroxime 500mg
every 8 hours; Hemarate 500mg 1 tablet once a day; monitor vital signs every 15 minutes until
stable and watch out for any untoward signs and symptoms. Her latest vital sign is T-37.4°C;
PR- 89bpm; RR- 17cycle/minute; BP 160/90mmHg. She was about to transfer in the room when
fully awake and stable.
I. Introduction
Placental abruption is the early separation of the placenta from the lining of the uterus before the
completion of the second stage of labor. It is one of the causes of bleeding during the second half of
pregnancy and is a relatively rare but serious complication of pregnancy that places the well-being of both
mother and fetus at risk. This activity describes the pathophysiology of placental abruption and highlights
the role of the interprofessional team in managing affected patients. Placental abruption is a relatively rare
condition but requires emergent management. The majority of placental abruptions occur before 37-
weeks gestation.
Placental abruption is one of the causes of vaginal bleeding in the second half of pregnancy. A
focused history and physical is critical to differentiate placental abruption and other causes of vaginal
bleeding. Because a definitive diagnosis of placental abruption can only be made after birth when the
placenta is examined the history and physical examination is critical to the appropriate management of the
maternal/fetal dyad. Placental abruption is a potentially life-threatening situation. Therefore, accurate
assessment of the patient is critical to developing an appropriate management plan and to prevent a
potentially poor outcome.
Placental abruption is a leading cause of maternal morbidity and perinatal mortality. With a placental
abruption, the woman is at risk for haemorrhage and the need for blood transfusions, hysterectomy,
bleeding disorders specifically disseminated intravascular coagulopathy, renal failure, and Sheehan
syndrome or postpartum pituitary gland necrosis. With the availability of blood replacement, maternal
death is rare but continues to be higher than the overall maternal mortality rate. Neonatal consequences
include preterm birth and low birth weight, perinatal asphyxia, stillbirth and neonatal death. Placental
abruption is a serious complication of pregnancy and is best managed by an interprofessional team of
healthcare professionals that include an obstetrician, radiologist, haematologist and an obstetric nurse.
II. Objectives
The main objective of this study is to provide the needed nursing care to a childbearing mother
diagnosed for abruption placenta. For the learners to acquire the knowledge, skills and attitude in
providing advices, health teaching to the patient and family for maternal and child care and management
of possible risk factors and other obstetric complications.
For the general objectives, this study aims to:
To obtain obstetric history of the patient;
To perform physical assessment to the childbearing mother;
To identify physiologic changes;
To provide health teaching to the patient and family;
To identify major and minor discomforts of the patient; and
To apply nursing care process to the patient.
At the end of the case study, the learners will be able to:
to define abruptio placenta;
to determine what causes early separation of a placenta from the lining of the uterus before
completion of the second stage of labor;
to gain knowledge about factors affecting the pregnancy; and
to fully understand and have confidence in handling similar cases in the future.
For the specific objectives, this study aims to:
Accurately present all assessments of the patient which includes physical assessment and family
history taking;
To understand the anatomy and physiology of the case study being presented;
To identify the nursing diagnosis;
To understand the role of drug in managing the client related to the diagnosis;
To efficiently formulate appropriate nursing care plan for the problems identified; and
To appropriately apply and exhibit nursing interventions necessary for the childbearing mother’s
condition diagnosed of abruption placenta.
III. Nursing Health History
Biographic Data
Name: E.Q
Age: 40 years old
Sex: Female
Marital Status: married
Religion: no data
Occupation: no data
Chief Complaint
Patient complained of moderate bleeding with mild to moderate uterine contractions.
Obstetric History
Her last menstrual period was October 10, 2019. The patient OB score is G1T1P0A0L1. She had
regular prenatal check ups.
History of Present Illness
The patient manifest mild uterine contraction with vaginal spotting three weeks prior to
admission.
Past Medical History
The patient’s family history reveals her mother is hypertensive and diabetic.
Lifestyle
The patient used to drink caffeine beverages and have fun eating junk foods, noodles for breakfast
and snacks in her workplace. She is also a known smoker at the age of 20 and consumed 6-7 sticks per
day and stopped when she got pregnant.
IV. Physical Examination
Physical assessment shows that patient is pale and has poor skin turgor.
Before admission the patient had mild to moderate bleeding and moderate contractions.
Vital signs taken results revealed:
Temp. 37°C;
PR: 88 bpm;
RR: 16cpm and
BP 120/80 mmHg,
Abdominal Ultrasound requested and revealed a live fetus, the placenta was attached to the anterior
uterine wall, but with a suggestive separation and rounding of the placental edge. Upon auscultation
the heartbeat of the baby is 100 beats/min.
As seen of the on the results of the physical examination done to the patient, the patient is pale
and has poor skin, it is due to the blood loss caused by the bleeding due premature separation of the
placenta as seen in the result of laboratory that the HCT and Hemoglobin levels are low. In placenta
abruption the abruption may be abruption may be excruciating, uncomfortable, or painless. The
patient may have contractions. With a concealed hemorrhage it is common for the uterus to remain
very tender, rigid, and board-like between contractions. Sometimes with a concealed hemorrhage, the
uterus may enlarge and change shape. Shock may be disproportionate to visible blood loss.
V. Anatomy and Physiology
Placental abruption occurs when the maternal vessels tear away from the placenta and
bleeding occurs between the uterine lining and the maternal side of the placenta. As the blood
accumulates, it pushes the uterine wall and placenta apart. These vascular structures deliver
oxygen and nutrients to the fetus. The placenta is the fetus’ source of oxygen and nutrients as
well as the way the fetus excretes waste products. Disruption of the vascular network may
occur when the vascular structures are compromised because of hypertension or substance
use or by conditions that causes stretching the uterus. The uterus is a muscle and is elastic
whereas the placenta is less elastic than the uterus. Therefore, when the uterine tissue
stretches suddenly, the placenta remains stable and the vascular structure connecting the
uterine wall to the placenta tear away.
Diffusion to and from the maternal circulatory system is essential to maintaining these life-
sustaining functions of the placenta. When accumulating blood causes separation of the
placenta from the maternal vascular network, these vital functions of the placenta are
interrupted. If the fetus does not receive enough oxygen and nutrients, it dies.
VI. Diagnostic and Laboratory
EXAMINATION RESULT NORMAL RANGE CLINICAL
SIGNIFICANCE
Hemoglobin 7.9 g/dL 12-16 g/DL low
Hct 29% 36-46 % Low hematocrit
Platelet Count 82,000/L 150,000- 400,000 low
Prothrombin time 11.2 seconds 11.0- 12.5 seconds normal
Na 146.5 135-145 high
K 3.85 3.5- 5.0 normal
Chloride 107.5 98-107 mEq/L high
RBC 5.6 million/mm3 4.2- 5.4 million cells/mcL high
Urinalysis Positive RBC Abnormal Could be a sign of infection
or complication.
VII. Drug Study
VIII. Nursing Care Plan
Defining Nursing Outcome Nursing Rationale Evaluation
Characteristics Diagnosis Identification Intervention
Subjective: Short Term: Independent: Goals met as
Patient Acute Pain After 2 hours of Keep the patient in To prevent pressure on evidenced
complained of related to nursing a lateral position the vena cava and by:
moderate sudden intervention, additional interference
bleeding, with separation of uterus of the with fetal circulation Maternal
mild to placenta from patient will not Note and vital signs
moderate the uterine wall be tensed and investigate changes To rule out worsening of are all within
uterine rigid. Bleeding from previous underlying condition or the normal
contractions. will be minimal. reports of pain. development of range.
complications.
Objectives: Rationale: Fetal heart
Physical Abruptio placent sounds are
Acknowledge the
assessment a, also called Long Term: patient’s Pain is a subjective within the
shows that placental description of pain experience and cannot normal
patient is pale, abruption, is After 4-6 hours and convey be felt by others. range.
poor skin turgor where the of nursing acceptance of Patient was
Temp. 37°C; placenta intervention, no patient’s response able to
PR: 88 bpm; separates from bleeding or to pain. demonstrate
RR: 16cpm and the uterine wall minimal amount use of
BP 120/80 prematurely, of bleeding Avoid performing To prevent further injury relaxation
mmHg, LMP: usually after the observed. any vaginal or to the placenta skills and
10/07/19, EDC: Maternal and abdominal other
20th week of
07/14/20. fetal vital signs examinations methods to
gestation,
Abdominal are all within the promote
Ultrasound producing normal range. comfort.
requested and haemorrhage. Dependent: This is to limit fetal
revealed a live anoxia
fetus, the Administer oxygen
placenta was by mask Once the patient starts to
attached to the bleed, the physician
anterior uterine Administer would order a large
wall, but with a Intravenous therapy gauge catheter to replace
suggestive fluid losses.
separation and
rounding of the
placental edge.
Upon
auscultation the
heartbeat of the
baby is 100
beats/min.
IX. Discharge Plan/ Health Teaching
Instruct patient to take the prescribed medications as directed. Contact the healthcare provider if
she thinks the medicine is not helping or if the patient is having side effects. Keep a list of the
medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them.
Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an
emergency. Restrict activities as directed, bed rest may be needed until the baby is ready to be born.
Bed rest means that you need to spend most or all of your day lying down. Avoid smoking as it can
limit the blood flow to the baby. The obstetrician may recommend to avoid sexual intercourse. Avoid
heavy lifting. These help prevent the condition from getting worse. Lastly, follow up with healthcare
provider as directed, the patient may need to return for more ultrasounds for further assessments and
evaluations.
