Abruption Placentae

Abruptio placentae occurs when the placenta breaks away from the uterus before its due time. This can occur anytime between the 20th week of pregnancy and the beginning of delivery and it begins in the deciduas basalis. Placental abruption can be dangerous for both mother and baby. The mother can lose a lot of blood, and the baby could die from lack of food and oxygen. All or only part of the placenta may break away from the uterus. There are three grades of Abruptio Placentae. They are Grade 1, which includes a mild separation of 10% - 20%; Grade 2, containing a moderate separation of 20% - 50%; and Grade 3, with a severe separation of greater than 50%.

Most of the time, the cause is from maternal hypertension, but there are other causes. Cocaine, blunt abdominal trauma, smoking, and poor nutrition are also present on the list of causes.

~~Decidua basalis (n) the area of endometrium between the implanted chorionic vesicle and the myometrium, which becomes the maternal part of the placenta. Also called deciduas serotina.

(http://medical-dictionary.thefreedictionary.com/decidua+basalis) ~~

Some expected abnormal labs would be:

Decreased CBC

Possibly a positive Kleihauer-Betke, which measures fetal cells in maternal circulation which would be used in assessing for Rh sensitization if the mother is Rh negative, or if there is a large antepartum bleed.

Positive Apt test (blood in the amniotic fluid.)

A decrease in H & H levels. (this may appear later)

A decrease in coagulation factor levels.

Three expected Nursing Diagnoses:

Three appropriate interventions for each diagnosis:

1. Risk for ineffective tissue perfusion: fetal related to uteroplacental insufficiency
   1. Increase intravenous fluid.
   2. Stop pitocin (if infusing)
   3. Lay on left side
   4. Assist doctor in getting the baby out as quickly as possible.
2. Fear related to threat to well-being of self and fetus.
   1. Use a calm reassuring approach; stay with the patient to promote safety and reduce fear.
   2. Use touch therapy to help to sooth the patient.
   3. Teach the client relaxation/breathing therapy.
3. Acute pain related to irritable uterus, hypertonic uterus.
   1. Ensure that the client receives attentive analgesic care (if ordered.
   2. Perform a comprehensive assessment of pain, including location, characteristics, onset/duration, frequency, quality, intensity or severity.
   3. Support the client's use of nonpharmacological methods to help control pain, such as distraction, imagery, relaxation, and application of heat and cold.

Major Concepts related to client's age/developmental level:

1. Erikson: intimacy vs. isolation. Their significant relationships are with partners and friends. Their goal is to find-giving and receiving-love. Some inappropriate ways to achieve this goal would be promiscuity and exclusivity. The avoidance of these experiences leads to isolation and self-absorption.

2. Piaget: The formal operational stage is the fourth and final stage in Piaget's theory. It begins at approximately 11 to 12 years of age, and continues throughout adulthood; although Piaget does point out that some people may never reach this stage of cognitive development. The formal operational stage is characterized by the ability to formulate hypotheses and systematically test them to arrive at an answer to a problem. The individual in the formal stage is also able to think abstractly and to understand the form or structure of a mathematical problem. Another characteristic of the individual is their ability to reason contrary to fact. That is, if they are given a statement and asked to use it as the basis of an argument they are capable of accomplishing the task. For example, they can deal with the statement "what would happen if snow were black".

3. Kohlberg: Postconventional: the attainment of true morality. Think in rational terms, valuing the will of the majority and the welfare of society. His contention is that the attainment of Postconventional moral reasoning is associated with optimal personal and social adjustment. A sense of obligation to law because of one's social contract to make and laws for the welfare of all and for the protection of all people's rights. A feeling of contractual commitment, freely entered upon, to family, friendship, trust, and work obligations.