📌 NCLEX Topic: Abruptio Placentae

📌 NCLEX Topic: Abruptio Placentae

NCLEX Topic: Abruptio Placentae

Description:

Abruptio placentae is the premature separation of the placenta from the uterine wall after 20 weeks of gestation but before the fetus is delivered. This is a life-threatening emergency for both the mother and fetus.

⚠️ KEY DIFFERENCE:

  • Placenta Previa: Painless, bright red bleeding
  • Abruptio Placentae: Painful, dark red bleeding, uterine rigidity

Causes & Risk Factors:

  • ✅ Hypertension (preeclampsia, chronic HTN)
  • ✅ Trauma (e.g., car accident, domestic violence, falls)
  • ✅ Cocaine use or smoking (vasoconstriction → placental detachment)
  • ✅ Previous history of abruptio placentae
  • ✅ Premature rupture of membranes (PROM)
  • ✅ Multiple pregnancies (twins, triplets)

Assessment Findings (Signs & Symptoms):

  • ✅ Dark red vaginal bleeding – May be minimal or absent if concealed.
  • ✅ Severe abdominal pain & uterine tenderness – A hallmark sign of abruptio placentae.
  • ✅ Uterine rigidity – Board-like abdomen due to trapped blood in the uterus.
  • ✅ Increased fundal height – Blood accumulation may cause uterine distension.
  • ✅ Signs of fetal distress – Late decelerations, absent variability, or bradycardia.
  • ✅ Signs of hypovolemic shock – Hypotension, tachycardia, pallor, dizziness, weak pulses.

🚨 If the bleeding is concealed, the absence of vaginal bleeding does NOT rule out abruptio placentae!

Nursing Interventions for Abruptio Placentae:

🚨 PRIORITY: Maintain maternal and fetal oxygenation, prevent shock, and prepare for delivery.

  1. Monitor maternal vital signs & fetal heart rate for distress.
  2. Assess for excessive vaginal bleeding, abdominal pain, and uterine rigidity.
  3. Maintain bed rest in lateral position or Trendelenburg (if fetal pressure needs to be relieved).
  4. Administer oxygen (8-10 L via face mask) to improve fetal oxygenation.
  5. Give IV fluids & blood products as prescribed to manage hypovolemia.
  6. Prepare for emergency cesarean delivery if fetal distress is present.
  7. Monitor for signs of Disseminated Intravascular Coagulation (DIC) postpartum.

⚠️ Vaginal delivery is preferred ONLY if the fetus is stable and engaged. Otherwise, an emergency C-section is performed.

NCLEX Test-Taking Strategy:

  • “Dark red vaginal bleeding” (Think abruptio placentae!)
  • “Severe abdominal pain, uterine rigidity” (Not seen in placenta previa)
  • “Signs of shock (hypotension, tachycardia)” (Indicates severe hemorrhage)

💡 Remember:

  • DO NOT perform a vaginal exam (risk of worsening bleeding).
  • Late decelerations = Fetal distress → Immediate intervention!
  • Uterine rigidity = Blood trapped in the uterus → Prepare for emergency delivery!

Summary for NCLEX:

  • 🚨 Abruptio Placentae is a life-threatening emergency!
  • 🩸 Key signs: Dark red bleeding, severe pain, uterine rigidity, and fetal distress.
  • ⚠️ PRIORITY: Oxygen, IV fluids, blood products, and emergency delivery if needed.