NCLEX Review Guide: Abruptio Placentae

Understanding Abruptio Placentae

• Abruptio placentae is the premature separation of a normally implanted placenta from the uterine wall before delivery of the fetus.
• This condition creates a life-threatening emergency for both mother and fetus due to hemorrhage and fetal hypoxia.
• The separation can be partial or complete, with bleeding that may be visible (external) or concealed (internal).

High-Risk Conditions

• Hypertensive disorders including preeclampsia, eclampsia, and chronic hypertension increase risk significantly.
• Maternal trauma from motor vehicle accidents, falls, or domestic violence can trigger placental separation.
• Previous history of abruptio placentae increases recurrence risk to 10-17% in subsequent pregnancies.
• Substance abuse, particularly cocaine and smoking, causes vasoconstriction leading to placental ischemia.
• Advanced maternal age (>35), multiparity, and rapid uterine decompression (polyhydramnios, multiple gestation) are additional risk factors.

Assessment Findings

• Sudden, severe abdominal pain that is constant and knife-like, different from labor contractions.
• Uterine rigidity and tenderness with inability to palpate fetal parts due to tetanic uterine contractions.
• Vaginal bleeding that may be dark red or absent if bleeding is concealed behind the placenta.
• Fetal distress evidenced by late decelerations, decreased variability, or absent fetal heart tones.
• Maternal signs of shock including hypotension, tachycardia, and decreased urine output may develop rapidly.

Immediate Priority Actions

1. Assess maternal vital signs and fetal heart rate - establish baseline and monitor continuously.
2. Position client in left lateral position to optimize uterine perfusion and venous return.
3. Establish two large-bore IV lines for rapid fluid resuscitation and blood product administration.
4. Obtain blood for type and crossmatch, CBC, coagulation studies, and prepare for possible transfusion.
5. Prepare for emergency delivery - cesarean section is often required for severe cases.

Maternal & Fetal Risks

• Disseminated Intravascular Coagulation (DIC) can develop due to release of thromboplastin from damaged placental tissue.
• Hemorrhagic shock from blood loss may require massive transfusion protocol activation.
• Fetal complications include hypoxia, growth restriction, preterm delivery, and fetal death in severe cases.
• Couvelaire uterus (uterine apoplexy) may occur when blood infiltrates uterine muscle, potentially requiring hysterectomy.

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