Abruptio Placentae

Definition

Abruptio placentae is the premature separation of a normally implanted placenta from the uterine wall after 20 weeks' gestation and before delivery. It is a leading cause of maternal and fetal morbidity and mortality in the third trimester.

Risk Factors

• Maternal hypertension (most common)
• Abdominal trauma (motor vehicle crash, intimate partner violence)
• Cocaine and methamphetamine use
• Advanced maternal age
• Previous abruption (recurrence rate up to 15%)

Clinical Presentation

Classic cues include sudden, painful, dark red vaginal bleeding; a rigid, board-like abdomen; uterine tenderness; and signs of fetal distress (late decelerations, loss of variability). Bleeding may be concealed in up to 20% of cases, so maternal shock can develop out of proportion to visible blood loss.

Nursing Considerations

Place the client in left lateral position, administer oxygen at 8 to 10 L/min via non-rebreather, establish large-bore IV access, and continuously monitor fetal heart rate and maternal vital signs. Prepare for immediate cesarean delivery if the fetus is viable and compromised. Monitor for disseminated intravascular coagulation (DIC), a frequent complication.

NCLEX Relevance

Differentiate abruptio placentae (painful bleeding, rigid uterus) from placenta previa (painless bright red bleeding, soft uterus). Never perform a vaginal exam with suspected abruption or previa.