Scribd Logo
Upload

Welcome to Scribd!

  • 73 views

    Abruptio Placenta and Abortion

    Uploaded by

    danica grace guba
    Abruptio placenta is the premature separation of the placenta from the uterine wall. It can cause heavy bleeding and restrict oxygen delivery to the fetus. Risk factors include advanced maternal age, prior abruptio placenta, smoking, hypertension, abdominal trauma, and preeclampsia. Symptoms include painful dark vaginal bleeding and a hard uterine wall. Diagnosis involves blood tests and ultrasound. Complications for the mother include shock, acute renal failure, and disseminated intravascular coagulation. Complications for the baby include intrauterine growth restriction, stillbirth, and neonatal death. Treatment involves bed rest, medications to stop contractions, steroids to mature the baby's lungs, and immediate delivery

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Abruptio Placenta and Abortion

    Uploaded by

    danica grace guba
    73 views10 pages
    Abruptio placenta is the premature separation of the placenta from the uterine wall. It can cause heavy bleeding and restrict oxygen delivery to the fetus. Risk factors include advanced maternal age, prior abruptio placenta, smoking, hypertension, abdominal trauma, and preeclampsia. Symptoms include painful dark vaginal bleeding and a hard uterine wall. Diagnosis involves blood tests and ultrasound. Complications for the mother include shock, acute renal failure, and disseminated intravascular coagulation. Complications for the baby include intrauterine growth restriction, stillbirth, and neonatal death. Treatment involves bed rest, medications to stop contractions, steroids to mature the baby's lungs, and immediate delivery

    Original Title

    abruptio placenta and abortion

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Abruptio placenta is the premature separation of the placenta from the uterine wall. It can cause heavy bleeding and restrict oxygen delivery to the fetus. Risk factors include advanced maternal age, prior abruptio placenta, smoking, hypertension, abdominal trauma, and preeclampsia. Symptoms include painful dark vaginal bleeding and a hard uterine wall. Diagnosis involves blood tests and ultrasound. Complications for the mother include shock, acute renal failure, and disseminated intravascular coagulation. Complications for the baby include intrauterine growth restriction, stillbirth, and neonatal death. Treatment involves bed rest, medications to stop contractions, steroids to mature the baby's lungs, and immediate delivery

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    73 views10 pages

    Abruptio Placenta and Abortion

    Uploaded by

    danica grace guba
    Abruptio placenta is the premature separation of the placenta from the uterine wall. It can cause heavy bleeding and restrict oxygen delivery to the fetus. Risk factors include advanced maternal age, prior abruptio placenta, smoking, hypertension, abdominal trauma, and preeclampsia. Symptoms include painful dark vaginal bleeding and a hard uterine wall. Diagnosis involves blood tests and ultrasound. Complications for the mother include shock, acute renal failure, and disseminated intravascular coagulation. Complications for the baby include intrauterine growth restriction, stillbirth, and neonatal death. Treatment involves bed rest, medications to stop contractions, steroids to mature the baby's lungs, and immediate delivery

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 10

    ABRUPTIO PLACENTA -premature separation of placenta from the uterine wall

    Risk Factors Causing Abrutio placenta


    • Maternal age
    • Previous history of abruptio placenta
    • Multiparity
    • Smoking – can cause vasoconstriction
    • Maternal hypertension
    • Abdominal trauma – example accident
    • PIH

    Pathophysiology
    •Small vessel rapture- due to strong vasocontraction

    •Bleeding lifts placenta because uterus is unable to contract and control bleeding.- because there is
    leakage, the pulling of blood in endometrium

    •Further Hemorrhage dissects off chorio decidual space

    •Due to uterine contractions blood flows through membranes and uterine walls separating them.

    •Blood escape through vagina - revealed hemorrhage

    •Tissue Damage and blood clots thrombo plastin -escape into maternal circulation through open sinuses
    -activate coagulation mechanism - fibrinogen converted to fibrin. – formation of clots
    Signs and symptoms of abruptio placenta
    • Concealed or visible bleeding
    • Painful bleeding
    • Dark red bleeding – unoxygenated blood
    • Board like abdomen – the uterus is contracted
    • Fetal distress – more than 160
    • Tetanic contraction – no resting phase
    HALLMARK SYMPTOMS:
    PAINFUL DARK RED VAGINAL BLEEDING

    Couvelaire's uterus – may clot sa layers ng uterus


    • Also called as Utero-placental apoplexy
    • First described by Couvelaire in early 1900
    • Extravasation of blood into uterine musculature & beneath uterine serosa
    • Demonstrated only at laparotomy
    • These myometrial hge interfere with uterine contraction to produce PPH

    Placental Grades
    A. Grade O - Patient asymptomatic. Small retroperitoneal clot seen after delivery.

    B. Grade 1 - Vaginal bleeding, may have abdominal tenderness or slight uterine tetany, mom and baby
    not in distress.
    C. Grade 2 - Uterine tenderness, tetany with or without evidence of bleeding, baby shows signs of
    distress.

    D. Grade 3 - Uterine tetany, severe bleeding may not be visible. Baby is dead. Mom often has
    coagulopathy.

    Complications of abruption placenta


    • Hypovolemic shock =more than 3000
    • Intrauterine growth restriction
    • Placenta accrete: attachment of placenta beyond uterine walls up to the urinary bladder
    • Maternal mortality
    • Fetal mortality
    • Congenital anomalies

    Diagnostic test
    • CBC
    • Blood typing
    • APTT/PT
    • Bleeding time
    • Clotting time
    • Serum electrolyte
    • Serum creatine
    • UA
    • USD
    • NST

    Placental Abruption: complications


    • Shock
    • Acute renal failure

    Cause: ? seriously impaired renal perfusion 2° to decrease CO and intrarenal vasospasm as in


    preeclampsia

    • DIC
    Consumptive coagulopathy 2° to hypofibrinogenemia along with elevated levels of fibrinogen-
    Fibrin degradation products

    Thromboplastin is the precursor of fibrin then conveted to fibrinogen to form clots

    Management of abruptio placenta


    • Bed rest
    • Tocolytic : duvadilan
    • Steroids: dexamethasone
    • Immediate delivery
    • Fluid and blood replacement
    • Always CS no NSVD

    NURSING CARE:
    • Assess and Monitor:

    Amount of Vaginal

    Bleeding Vital Signs

    • I and O
    • Measure abdominal girth
    • Uterine characteristics and activity EFM-Continuously
    • For development of coagulation problems
    • Review lab values: CBC, Coagulation studies, PT,PTT

    Nursing Diagnosis
    • Altered tissue perfusion
    • Fluid volume deficit
    • Risk for infection
    • Anxiety
    • Acute pain

    Characteristic Placenta previa Abruptio placenta


    Onset Third trimester commonly @ Third trimester
    32-26 weeks
    Bleeding Mostly external, small to May be concede, external dark
    profuse in amount, bright re hemorrhage or bloody
    ammonitic fluid
    Pain and uterine tenderness Usually absent; uterus soft Usually present; irritable uterus,
    progresses to board like
    consistency
    Fetal heart tone Usually normal Maybe irregular or absent
    Presenting part Usually not engaged May be engaged
    Shock Usually not present unless Moderate to severe depending
    bleeding is excessive on extent of concealed and
    external hemorrhage
    Delivery Delivery may be delayed Immediate delivery, usually by
    depending on size of fetus and CS section
    amount of bleeding
    ABORTION

    Abortion - termination of pregnancy before the age of viability

    • Spontaneous abortion
    - threatened abortion
    - imminent abortion
    - complete abortion
    - incomplete abortion
    - missed abortion
    - recurrent/ habitual abortion
    - septic abortion

    Pathophysiology/Etiology
    1. Cause frequently unknown, but 50% are due to chromosomal anomalies – sa DNA
    and RNA structure
    2. Exposure or contact with teratogenic agents – example medication
    3. Poor maternal nutritional status-
    4. Maternal illness with or specific bacterial microorganisms – example UTI
    5. History of diabetes, thyroid disease,
    6. Smoking or drug abuse or both
    7. Immunologic factor
    8. Luteal phase defect – in menstruation
    9. Postmature sperm or ova
    10. Structural defect in the maternal reproductive system (including an incompetent
    cervix)

    Causes of recurrent miscarriage/ spontaneous abortion


    RIB CAGE
    Radiation

    Immune reaction

    Bugs ( infection)

    Cervical incompetence

    Anatomical anomaly (uterine septum etc.)

    Genetic (aneuploidy , balanced translocation etc)

    Endocrine
    Chemiotactic activity – inflammatory response

    If the WBC especially the neutrophils is attracted to the site of


    infection

    Cytokines is responsible for inflammatory response and foe defense


    mechanism.
    Types of sponatneous abortions
    1. Thretened abortion – vaginal bleeding occure, no rupture
    2. Inevitable abortion- membranes rupture and cervix dialtes
    3. Incomplete abortions- some products of conception have been expelled, but some remain

    Induced abortion
    1. Therapeutic abortion
    2. Eugenic abortion

    Secondary abortion – napatay si baby sa tyann pero hindi na labas

    Types of miscarriage
    1. Missed
    - no vaginal bleeding
    -close cervical os
    - no fetal cardiac activity or empty sac

    2. Threatened
    - vaginal bleeding
    - closed cervical os
    - fetal cardiac activity
    3. Inevitable
    - vaginal bleeding
    - dilated cervical os
    - products of conception may be seen or felt at or above cervical os

    4. Incomplete
    - vaginal bleeding
    - dilated cervical os
    - some products of conception expelled and some remain

    5. Complete
    - vaginal bleeding
    - closed cervical os
    - products of conception completely expelled
    Inevitable Abortion
    - Immediate evacuation of pregnancy.

    (If duration of pregnancy less than 12 weeks suction evacuation and greater than 12 weeks oxytocin
    infusion.)

    - Shock-resuscitation with i/v fluids and blood transfusion.

    - Prophylactic antibodies and anti-D.

    Management of threated abortion


    • Bed rest
    • Tocolytic medications (Isoxuprine HCL: Duvadilan)
    • Treat underlying factors
    • No sexual activity
    • Fetal monitoring by ultrasound
    • Avoid stress

    Threatened Abortion
    - Conservative with bed rest and reassurance till bleeding stops .

    - Sexual intercourse best avoided.

    - Follow up with UL TRASOUND-f2rresence of fetal cardiac activity predicts good outcome in 95%of
    cases.

    - Hormone therapy -400mg natural progesterone in divided doses orally or vaginally on empirical basis.

    - Anti D if mother is Rh negative and pregnancy is beyond 12 weeks

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy