Group 1: Camposano, Lynn Cielo, Divina Gracia Edem, Katrine Tricia Ibalin, Jasmin Rodriguez, April Rose

CASE
ANALYSIS
GROUP 1:
Camposano, Lynn
Cielo, Divina Gracia
Edem, Katrine Tricia
Ibalin, Jasmin
Rodriguez, April Rose
ASSESSMENT
PATIENT'S PROFILE
• NAME: Patient X
• AGE: 35 years old
• STATUS: Married
• ADDRESS: Kiwalo, Daraga, Albay
• G4P2, AOG 36 weeks

VITAL SIGNS
• BLOOD PRESSURE: 60/50 mmhg
• PULSE RATE: 100 bpm
• RESPIRATORY RATE: 40 bpm
• BODY TEMPERATURE: 35.6 °C

CHIEF COMPLAINTS
• Profuse bleeding and abdominal cramps for 3

days.
DIAGNOSIS
• According to the patient's chief complaint she
experienced profuse bleeding and abdominal cramps for
3 days and upon the results of taken vital signs which are
the following: Blood pressure- 60/50 mmhg, Pulse rate-
100 bpm, Respiratory rate- 40 bpm, and Body
temperature- 35.6 °C.
• The patient was suffering from hypotension, tachycardia,
tachypnea, and hypotermia that may be related to
hypovolemic shock.
• Patient was suferring from profuse bleeding taht may lead to
anemia.
• Upon the observation of the symptoms, based on her age,
previous abortion, and AOG , she was diagnosed of Abruptio
Placenta.
• Moreover, patient X undergone CBC, Clotting studies,
Blood Urea Nitorgen test, Urinalysis, Biophysical
profile, Kleihauer-Betke test, Ultrasound examination,
and continues taking of vital signs for maternal and
fetal monitoring as per doctor's order.
ABRUPTION
PLACENTA
• Abruptio placenta is the premature separation of
normally implanted placenta after 20 weeks of
gestation and before delivery of the fetus. It is also
called ablatio placenta, placental abruption,
accidental hemorrhage.
SIGNS AND
SYMPTOMS
Manifestations vary depending on
the type of abruptio placenta or the
manner of separation.
1. Vaginal bleeding occurs in 80% of
women
• Dark red vaginal bleeding is the usual manifestation in covert
type abruptio placenta.
• Bright red vaginal bleeding is the usually seen in overt type

abruptio placenta.
• If the woman develops shock because of bleeding, it is usually

out of proportion to the amount of blood loss.
2. Abdominal pain
• Uterine irritability and low back pain will occur in 2/3 of patient
with abruptio placenta.
• With mild abruption mother may complain of “labor pains” and
there may be only slight uterine irritation.
• With moderate abruption, pain can develop gradually or abruptly.
In severe abruption pain can be sudden and described as knife-
sharp. the pain can both localized and diffused over the abdomen.
• Sharp pain over the fundus may be experienced as the placenta
separates.
• Escalating abdominal pain indicates a concealed bleed.
3. Board like abdomen caused by
accumulation of behind the placenta with
fetal parts hard to palpate.
4. Signs od shock and fetal distress if
bleeding are severe.
ETIOLOGY
CAUSES OF CONDITION
• Maternal hypertension is the common and consistent
associated factor
• Advanced maternal age
• Grand multiparity. It is associated with increased

endometrial damage and thinning of the endomentrium that
prevents proper attatchment of the placenta to the decidua
• Trauma to the uterus

• Rapid decompression of an over-distended uterus
• Short umbilical cord
• Uterine leiomyoma or fibroids
• Behavioral risk factors:
Cigarette smoking, methamphetamine, and cocaine abuse
cause spasms and vasoconstriction that can lead to
decidual necrosis.
Maternal alcohol consumption (14 or more drinks per
week)
ANAPHYSIOL
OGY
PATHOPHYSIOL
OGY
• Abruptio placenta is believed to be caused by degenerative
changes in the spiral arteriols that consequently decrease blood
supply to the decidua that resulted to decidual tissues and
blood vessels undergo necrosis, blood vessels rupture, bleeding
occurs and blood escaping from the ruptured vessels collects
between the decidua and placenta. This collection of blood
creates increasing amounts pressure against the placenta that
pushes the placenta further and further away thereby enlarging
the degrees of placental separation from the decidua.
• Placenta separates from the uterus, the blood supply from the
uterus to the placenta is cut off preventing proper exchange of
substances between the placenta and the uterus which leads
to deprives the fetus with necessary oxygen and nutrients.
Prolonged poor placental perfusion results in intrauterine
growth retardation (IUGR), fetal distress, and hypoxia as the
fetus is no longer properly noursihed and supplied with oxygen.
CLASSIFICATION ACCORDING TO
PLACENTAL SEPARATION
• COVERT/ CENTRAL ABRUPTIO PLACENTA: Separation begins at
the center of placental attatchment resulting in blood being trapp
behind the placenta, bleeding, then, is internal and not obvious.
• OVERT/ MARGINAL ABRUPTIO PLACENTA: Separation begins at

the edges of the placenta allowing blood to escape from the
uterine cavity. Bleeding is external.
CLASSIFICATION ACCORDING TO
SIGNS AND SYMPTOMS
• GRADE 0: No symptoms, diagnosed after delivery when placenta is
examined andound to have replacement clot- is a dark, adherent clot on
the maternal surface.
• GRADE 1: Some external bleeding, uterine tetany and tenderness may or
may not be noted, absence of fetal distress and shock.
• GRADE 2: External bleeding, uterine tetany, uterine tenderness, and fetal
distress.
• GRADE 3: Internal and external bleeding (more than 1000 cc), uterine
tetany, maternal shock, probably fetal death, and DIC.
CLASSIFICATION ACCORDING TO EXTENT OF
SEPARATION
• MILD: less than 1/6 of the placenta is separated from the
uterus. Bleeding may or may not be present (<250 cc).
Some uterine irritability with no fetal distress. There may or
may not be vaginal bleeding. There may be some uterine
tenderness and vague backache.
• MODERATE: approximately 1/6 to 2/3 of the placenta is
separated from the uterus. Dark vaginal bleeding may be
absent or present (<1000 ml). Uterine tenderness and
tetany are present. The fetus will exhibit distress due to
uteroplacental insufficiency.
• SEVERE: more than 2/3 of the placenta is separated from the
uterus causing continuous uterine tenderness and rigidity along
with sever pain. Dark va bleeding (>1000 ml), however bleeding
may be absent. Fetal distress will develop and if the fetus is not
delivered death of the fetus is inevitable. Entire separation of
the placenta will cause maternal shock, fetal death, severe pain,
and possible disseminated intravascular coagulation.
LABORATORY
AND
DIAGNOSTIC
TESTS
CBC, CLOTTING STUDIES, & BUN
• Blood work, including a CBC, clotting studies

(fibrinogen and PT/a-PTT), and BUN provide baseline
parameters to evaluate changes in the patient’s
status. A type and Rh have been obtained if a blood
transfusion is necessary.
URINE ANALYSIS
BIOPHYSICAL PROFILE
• A biophysical profile may be used in the management

of patients with marginal placental abruption who are
being conservatively treated. A score of 6 or below is
an indicator of compromised fetal status.
KLEIHAUER-BETKE TEST
• A Kleihauer-Betke test, which detects fetal blood cells in
maternal circulation may be ordered. A Kleihauer-Betke test
does not diagnose the presence of placental abruption, but
it quantifies the presence of fetal blood into the maternal
circulation. This knowledge is important in women who are
Rh-negative, because the mixing of fetal blood in the
maternal circulation may lead to isoimmunization.
Therefore, if a significant fetal-maternal bleed is present, the
Kleihauer-Betke test results will help to determine the
needed dose of Rh (D) immune globulin to prevent
ULTRASOUND EXAMINATION
• An ultrasound examination is useful in determining the
placental location and eliminating the diagnosis of placenta
previa. However, the sensitivity of ultrasound in visualizing
placental abruption is low. During the acute phase of
placental abruption, the hemorrhage is isoechoic or similar
to the surrounding placental tissue. Therefore, visualization
and differentiation of the concealed hemorrhage associated
with placental abruption from the surrounding placental
tissue are difficult.
BLOOD PRESSURE, PULSE, RATE, &
BODY TEMPT.
• Useful for monitoring patient's vital signs and for
future comparison of present and previous vital
signs taken.
MEDICATION
OXYGEN THERAPY
• Oxygen therapy is a treatment that delivers oxygen gas to breathe.
Oxygen therapy from tubes resting in your nose, a face mask, or a
tube placed in trachea, or windpipe. This treatment increases the
amount of oxygen in lungs receive and deliver to blood.
• Oxygen using a nasal cannula at 4 to 6 liters to supply both

mother and fetus
IVF: LACTATED RINGER
• Ringer's lactate solution (RL), also known as sodium lactate solution and
Hartmann's solution, is a mixture of sodium chloride, sodium lactate,
potassium chloride, and calcium chloride in water. It is used for replacing
fluids and electrolytes in those who have low blood volume or low blood
pressure.
• Usually used and run at 125 cc per hour to rapidly replace blood lost. If
fluid is to be rapidly infused, use a warmer attatchment to prevent chilling
and a fall in the maternal core temperature.
TOCOLYTIC THERAPY
• Drugs that prevent preterm labor and immature birth by
suppressing uterine contractions (TOCOLYSIS).
• Includes Magnesium Sulfate, Ritodrine, or Terbutaline.
Magnesium Sulfate- is a naturally occurring mineral used to
control low blood levels of magnesium.
Ritrodine- Ritodrine is used to stop premature labor. This
medicine was available only with your doctor's prescription.
Terbutaline- used to prevent and treat wheezing, shortness of
breath, and chest tightness. Terbutaline is in a class of
medications called beta agonists. It works by relaxing and
opening the airways, making it easier to breathe.
INTERVENTIO
N
Management bleeding episodes
• Place the patient on sidelying position to promote optimum
placental prefusion.
• Insert a foley cathether to accurately record urine ouptut.
Urine output should be at least 30 cc per hour.
• Put patient on NPO status.
• Provide oxygen theraphy using an nasal cannula at 4 to 6
liters to supply borth mother and fetus.
• Observe and record the amount and time of bleeding at
least every 30 minutes or more often if necessary.
Management bleeding episodes
• Assess the status of the abdomen, whether board-like,
tender or soft.
• Mark the fundus of the uterus to observe for any sudden
increase in fundal height indicating a concealed bleed.
• Monitor vital signs and manifestation of shock.
• Assess uterine constraction.
• Blood typing and cross matching. Have at least 3 to 4 units
of blood available in case of severe hemorrhage.
• Administer IVF, usually Ringer Lactate is used and run at 125
cc per hour to rapidly replace blood lost.
•Ultrasound is necessary to differentiate
abruptio placenta from placenta previa.
•Monitor fetal condition by daily
nonstress test and kick counts.
Administer prescribed medications:
• Tocolytics theraphy if patient is in labor to inhibit uterine
contraction. Drugs used for tocolytic therapy include Magnseium
Sulphate, Ritodrine, or Terbutaline... contraindicated in patients
with moderate to severe abruptio placenta. By minimizing pain
and uterine hypertonicity, tocolytics will disguise andy signs and
symptoms and will interfer with the proper diagnosis of placenta
abruption.
Observe for signs of DIC
• Assess for bleeding at puncture sight, nose and gums,
tachycardia and petechiae.
• If there is severe bleeding a “clot test” may be obtained.
• Coagulation studies that inclue : fibrinogen level, prothrombin

time (PT), partial prothrombin time (PPT), complete blood
count, anticoagulant factor, and electrolytes.
Delivery
• Emergency cesarean section is undertaken when

rapid delivery is needed in instances of
distressed fetus or uncontrolled bleeding.
• Provide and client family teaching.
• Address emotional and psychosocial needs.

NUTRITION
DIET (ON GOING CARE)
• Manage as potentially an acute obstetric surgical

complication and thus NPO until reasonable stability is
assured and possibility of immediate cesarean
delivery is concluded.
DIET (POSTPARTUM)
• Foods high in iron.
Iron is a mineral, and its main purpose is to carry oxygen in the
hemoglobin of red blood cells throughout the body so cells can
produce energy. Iron also helps remove carbon dioxide.
• Because of the risk of anemia, Vitamin C is included in diet
to improve intestinal iron absorption.
• Increase in fiber intake will minimize constipation and
straining which could precipitate vaginal bleeding.
MIDWIFERY
CARE PLAN
THAN
K YOU

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CASE

• AGE: 35 years old

• ADDRESS: Kiwalo, Daraga, Albay

• G4P2, AOG 36 weeks

• PULSE RATE: 100 bpm

• RESPIRATORY RATE: 40 bpm

• BODY TEMPERATURE: 35.6 °C

• Profuse bleeding and abdominal cramps for 3

• Bright red vaginal bleeding is the usually seen in overt type

• If the woman develops shock because of bleeding, it is usually

• Advanced maternal age

• Grand multiparity. It is associated with increased

• Trauma to the uterus

• OVERT/ MARGINAL ABRUPTIO PLACENTA: Separation begins at

• Blood work, including a CBC, clotting studies

• A biophysical profile may be used in the management

• Oxygen using a nasal cannula at 4 to 6 liters to supply both

• If there is severe bleeding a “clot test” may be obtained.

• Coagulation studies that inclue : fibrinogen level, prothrombin

• Emergency cesarean section is undertaken when

• Address emotional and psychosocial needs.

• Manage as potentially an acute obstetric surgical

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