POLYTECHNIC COLLEGE OF DAVAO DEL SUR Barangay Kiagot, Mac Arthur Highway, Digos City

In Partial Fulfillment of the Requirements In Nursing Care Management 104

______________________________________________________________________

Presented to Ms. Deanne Dee Monday, RN

Presented by Evelyn Melecio

July 2010

Abruptio Placenta Abruptio placenta is defined as the premature separation of the placenta from the uterus.

Types: 1. Marginal like Duncans separation 2. Central like Schultz separation

Risk Factors: Increasing maternal age & parity Maternal hypertension, toxemia Sudden release of amniotic fluid Direct trauma Short umbilical cord Hypofibrinogenaemia deficiency of the clotting factor fibrinogrn in the blood. Cigarette smoking

Manifestations: PAINFUL, vaginal bleeding Hard, boardlike abdomen (due to bleeding) Rigid abdomen Fetal bradycardia

Nursing Management: Monitor Fetal Heart Tone & maternal vital signs
The fundus may be monitored because a rising fundus can indicate bleeding. Avoid IM injections can cause bleeding into the muscle tissues. If to be

given, provide firm pressure over the injection site.

Blood volume replacement and to maintain blood pressure and blood plasma

replacement to maintain fibrinogen levels may be needed.

The mother may be given Rhogam if she is Rh negative.

Medical Management:
It depends upon the condition of the mother & fetus at the time the diagnosis

is made. If the fetus is alive, prompt C-section is needed. If there is Fetal Death in the Uterus, vaginal delivery is indicated. Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Excessive bleeding from uterus may necessitate hysterectomy if family size is completed.

Complications: 1. Hemorrhage 2. Infection 3. Prematurity 4. Fetal Death in the Utero

PATHOPHYSIOLOGY

A. Schematic Diagram Predisposing Factors Age Parity

Precipitating Factors Hypertension Direct Trauma Hypofibrinogenaemia

avulsion of the anchoring placental villi from the expanding lower uterine
segment

Bleeding into the decidua basalis

stretches and thins the vessel wall

push the placenta away from the uterus and cause further bleeding

Hard, boardlike abdomen

PAINFUL, vaginal bleeding

Rigid abdomen

Fetal bradycardia

MANAGEMENT: > It depends upon the condition of the mother & fetus at the time the diagnosis is made. If the fetus is alive, prompt C-section is needed. If there is Fetal Death in the Uterus, vaginal delivery is indicated.

If not treated: > complications may occur such as Hemorrhage, Prematurity, Infection, & Fetal Death in the Utero

Narrative

Through the process of Abruptio Placenta, certain risk factors increase its likelihood. Among the predisposing factors are Marital Age and Parity while Precipitating factors include hypertension, direct trauma, and Hypofibrinogenaemia.

These risk factors contribute to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. Decidua Basalis is the area of endometrium between the implanted chorionic vesicle and the myometrium, which becomes the maternal part of the placenta. Bleeding into the decidua basalis can push the placenta away from the uterus and cause further

bleeding. This leads to painful, vaginal bleeding, hard, boardlike abdomen (due to bleeding), rigid abdomen, and fetal bradycardia.

Treatment depends upon the condition of the mother & fetus at the time the diagnosis is made. If the fetus is alive, prompt C-section is needed. If there is Fetal Death in the Uterus, vaginal delivery is indicated. If not treated, complications may occur such as Hemorrhage, Prematurity, Infection, & Fetal Death in the Utero.

PATHOPHYSIOLOGY A. Schematic Diagram Predisposing Factors Age Gender Elevated systolic and diastolic pressures A defect in the media and elastica of the vessel wall

Precipitating Factors Long term condition (Hypertension) Sedentary lifestyle

Weakens the vessel wall stretches and thins the vessel wall

Vessel ruptures intracerebral hemorrhage occurs

Vasospasm

Loss of consciousness

Aphasia

Paralysis

Coma

MANAGEMENT: > Rehabilitative therapies can help with this process which includes proper medical management and medications.

If not treated: > complications may occur such as decubitus ulcers, aspiration pneumonia, and even death.

Narrative Through the process of CVA, certain risk factors contribute to its development. Among the predisposing factors are Age and Gender while Precipitating factors include long term conditions as major risk factors such as hypertension and heart diseases, tobacco use, smoking, and sedentary lifestyle. In CVA, vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the spaces surrounding the brain (ventricular, subdural, subarachnoid). Hemorrhage into the brain tissue generally reults from a ruptured saccuilar aneurysm, rupture of an arteriovenous malformation or, more commonly, hypertension. Elevated systolic and diastolic pressures cause changes within the arterial wall that leave it susceptible to rupture. An intracerebral hemorrhage occurs when the vessel ruptures. A defect in the media and elastica of the vessel wall weakens it and continued force on the weakened vessel wall from elevated blood pressure stretches and thins the vessel wall. Vasospasm, a sudden and transient constriction of a cerebral artery, often accurs after a cerebral hemorrhage. Blood flow to distal areas of the brain supplied by the artery is markedly diminished, which leads to loss of conscoiusness, aphasia, paralysis, and coma. Rehabilitative therapies can help with this process which includes proper medical management and medications. If not treated, complications may occur such as decubitus ulcers, aspiration pneumonia, and even death.