c. Nursing implications are listed below.
Teach the patient to report any painless vaginal bleeding.
Monitor vital signs. Hypovolemic shock may be present.
Monitor fetal heart tones per orders.
1-14. ABRUPTIO PLACENTAE
a. Abruptio placentae is hemorrhage resulting from the detachment of the
placenta. Hypertension may cause this. It may occur any time during pregnancy. If the
placenta becomes detached prior to the 20th week of gestation it is called a
b. Abruptio placentae may be classified in three types of separation (see
(1) Marginal/low separation. This occurs when the separation is low and is
not complete; vaginal hemorrhage is evident.
(2) Moderate/high separation. This occurs when the separation is high in
the uterine segment, causing the fundus of the uterus to rise. The fetus is in grave
danger because of lack of oxygen. External hemorrhage will probably not be present
here, whereas the amniotic fluid will be a port-wine color.
(3) Severe/complete separation. This occurs when the fetus head is
present in the cervical os that prevents external hemorrhage. The fetus is in grave
danger, and an immediate cesarean section will probably be needed in order to save
the baby's and mother's lives.
Figure 1-6. Types of abruptio placentae.