Kleihauer-betke test placental abruption on ultrasound

Placental abruption is a potentially life-threatening situation. Therefore, accurate assessment of the patient is critical to developing an appropriate management plan and to prevent a potentially poor outcome. The history begins with a review of the prenatal course, especially placental location on prior sonograms and if there is a history of placental abruption in previous pregnancies.

Asking about potential trauma, especially in the abdominal area needs to be done in a tactful and supportive manner. Especially in situations of partner abuse, the woman may be reluctant to reveal that she sustained trauma to her abdomen. The most useful mechanism for recognizing the onset of placental abruption is an assessment of the patient. The physical examination includes palpation of the uterus. The uterus is palpated for tenderness, consistency, and frequency and duration of uterine contractions, if present.

The vaginal area is inspected for the presence of bleeding. However, a digital examination of the cervix should be delayed until a sonogram is obtained for placental location and to rule out a placenta previa. If bleeding is present, the quantity and characteristic of the blood, as well as the presence of clots, is evaluated. Remember, the absence of vaginal bleeding does not eliminate the diagnosis of placental abruption.

Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage are taken. Blood specimens such as a complete blood count CBC , fibrinogen, clotting profile, and type and RH may be collected. Evaluation of fetal well-being is also included in the examination.

Begin with auscultation of fetal heart sounds and ask about fetal movement, specifically recent changes in activity patterns. Continuous electronic fetal monitoring is initiated to identify prolonged bradycardia, decreased variability, and the presence of late decelerations.

Evaluation There are no laboratory tests or diagnostic procedures to definitively diagnose placental abruption. However, some studies may be conducted in the effort to eliminate other conditions as well as to provide baseline data. However, the sensitivity of ultrasound in visualizing placental abruption is low.

During the acute phase of placental abruption, the hemorrhage is isoechoic or similar to the surrounding placental tissue. Therefore, visualization and differentiation of the concealed hemorrhage associated with placental abruption from the surrounding placental tissue are difficult.

A biophysical profile may be used in the management of patients with marginal placental abruption who are being conservatively treated. A score of 6 or below is an indicator of compromised fetal status. A type and Rh have been obtained if a blood transfusion is necessary. A Kleihauer-Betke test, which detects fetal blood cells in maternal circulation may be ordered. A Kleihauer-Betke test does not diagnose the presence of placental abruption but quantifies the presence of fetal blood into the maternal circulation.

Risk factors include smoking, trauma, hypertensive disorders, and cocaine use. Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable. Management and outcome depend on the gestational age, the degree of separation, and the maternal and fetal status.

Definition The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus. Placental abruption. Obstet Gynecol.

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Possible causes include trauma or injury to the abdomen due to an accident. It can also result from oligohydramnios, which is the rapid low levels of amniotic fluid. The risk factors that increase the likelihood of Abruptio Placentae include: History of abruptio placentae that is not cause by traumatic abdominal injury Chronic hypertension Hypertension-related problems during preeclampsia, eclampsia, HELLP syndrome which stands for Hemolysis, Elevated liver enzymes and Low Platelet levels Abdominal trauma — usually due to fall Smoking Drug abuse during pregnancy — specifically cocaine Early rupture of membranes Chorioamnionitis — intrauterine infection during pregnancy Age — mothers aged 40 and above Complications of Placental Abruption Abruptio placentae impose a variety of complications that are life-threatening for both the mother and her unborn child.

Maternal complications may lead to: Blood clotting problems that may lead to DIC Disseminated Intravascular Coagulation Multi-organ failure as result of insufficient blood supply in the circulation. Hysterectomy, or the surgical resection of the uterus. This is done to prevent more blood loss brought upon by Abruptio Placentae. Kleihauer-Betke test — to determine the volume of fetal blood transfused into the maternal circulation.

This will also determine the appropriate dosage of Rh D immune globulin for significant fetal-maternal hemorrhage. Ultrasound — to eliminate differential diagnoses of third trimester bleeding besides Abruptio Placentae. Late decelerations and fetal bradycardia are indicative of fetal distress. Furthermore, increased uterine resting tone, along with frequent contractions, may progress to hyperstimulation of the uterus. Biophysical profile — to evaluate patients with chronic abruptions, who are managed conservatively.

BPP scores of 6 and below from a maximum score of 10 is an early sign of fetal distress and compromise. Treatment for Placental Abruption The management of Abruptio placentae includes careful planning, initial control of symptoms, the manner of fetal delivery, dietary and lifestyle modification, and the use of tocolytics.

Due to the nature of the condition, consideration of inpatient admission to a hospital with ICU and neonatal ICU is warranted before fetal delivery. Monitoring for fetal heart tones and contractions, stabilizing hemodynamic status through fluid resuscitation or blood transfusions, correction of coagulopathy, administration of Rh immune globulin if patient is Rh negative and initiation of corticosteroid for fetal lung maturity for less than 37 weeks gestation are implemented as initial treatment measures.

Manner of Fetal Delivery. Caesarian section is the standard approach to stabilize the maternal and fetal health. Also, during C-section can the surgeon properly address and control the bleeding brought about by the condition. A modified bedrest regimen is prescribed to limit maternal and fetal distress. The following medications can be considered in a patient with Abruptio placentae: Tocolytics or anti-contraction drugs — used for premature labor suppression.

Tocolysis is controversial and is only considered for patients hemodynamically stable and have no evidence of fetal threat. Calcium channel blockers — utilizing this prohibits the influx of calcium to the uterine walls, thus decreasing contractions Magnesium sulfate — drug of choice for managing Abruptio placentae. Also acts as neuroprotection for maternal seizures Corticosteroids — used to aide in lung maturity for preterm fetus with abruptions Placental Abruption Nursing Diagnosis Nursing Care Plan for Placental Abruption 1 Nursing Diagnosis: Altered Uteroplacental Tissue Perfusion related to maternal bleeding secondary to abruptio placentae, as evidenced by vaginal bleeding, abnormal uterine contractions, abdominal and uterine tenderness and pain, and changes in fetal heart rate Desired Outcome: Patient has stable vital signs and the baby has a stable fetal heat rate.

Placental Abruption Nursing Interventions Rationales Admit the patient and perform close monitoring for both the mother and the baby. Decrease in fetal activity may mean fetal compromise or distress, which requires immediate medical attention and monitoring through hospitalization.

Provide the necessary treatments for maternal hemodynamic stabilization such as intravenous fluid resuscitation or blood transfusion. Monitoring for fetal heart tones and contractions, stabilizing hemodynamic status through fluid resuscitation or blood transfusions, correction of coagulopathy, and administration of Rh immune globulin if patient is Rh negative. Administer corticosteroid as prescribed. Administer corticosteroid for fetal lung maturity for less than 37 weeks gestation as an initial treatment measure.

Encourage the pregnant patient to follow a healthy lifestyle, such as smoking cessation and avoidance of illegal drug use, proper hydration, enough sleep, and appropriate diet. Fetal movement and activity can be affected by cigarette smoking, drug abuse, dehydration, sleep deprivation, and poor dietary choices.

Monitor fetal growth by measuring the fundus and check fetal heart rate at each clinic visit. To determine if the baby is experiencing intrauterine growth retardation related to abruptio placentae. If the baby needs to be delivered prematurely, give IM corticosteroids as prescribed, not more than 7 days prior to expected date of delivery.

To enhance the production of surfactants which are necessary to speed up the pulmonary maturity of the fetus and avoid respiratory distress syndrome. Placental Abruption Nursing Interventions Rationale Assess vital signs, conduct physical examination, and commence daily weight monitoring.

Fluid retention may be evident if the mother has a weight gain of more than 1. Start input and output monitoring. To monitor circulatory blood volume. To ensure that the mother has adequate oral hydration or if there is a need to commence IV hydration therapy.

Speak to the patient and family about the need for hospitalization for severe abruptio placentae or serious hemorrhage. To closely monitor the symptoms of abruptio placentae and deficient fluid volume in the appropriate setting. Prepare the patient for C-section and surgical intervention related to maternal bleeding. For heavy bleeding, immediate C-section will be performed, regardless if the fetus is premature or in full term. Corrective surgery to control the bleeding will also be done and may involve some surgical techniques as appropriate.

Prepare for blood transfusion as required. To increase blood volume. Refer the patient to a dietitian for proper monitoring and advice of salt, caloric and protein intake. Consuming salt between 2 to 4 g per day is ideal as an extremely low salt intake may increase dehydration, while high salt intake may cause edema formation. Nursing Care Plan for Placental Abruption 3 Risk For Shock Nursing Diagnosis: Risk for Shock related to uterine malformations, multiple pregnancies, hypertension, history of cesarean delivery, renal or vascular disorders, abdominal trauma, previous third trimester bleeding, huge placenta, and a short umbilical cord secondary to placental abruption.

As a risk nursing diagnosis, the Risk for Shock is utterly irrelevant to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead. Desired Outcomes: The patient will be hemodynamically stable. The patient will be able to regain vital signs at an average level.

The patient will be able to verbally express his or her knowledge of the disease process, risk factors, and care plan. The patient will have normal central venous pressure. The patient will have warm and dry skin. The patient will produce an acceptable urine volume with normal specific gravity.

The patient will exhibit his or her usual level of mentation. Placental Abruption Nursing Interventions Rationale Examine the patient for a history or the presence of disorders that could lead to hypovolemic shock. Hypovolemic shock is an emergency health condition in which the heart cannot pump enough blood to the body due to substantial blood or other fluid loss. Many organs may stop working as a result of this type of trauma.

Observe the patient thoroughly for persistent or substantial fluid or blood loss. When a person loses too much blood, the body experiences shock. As a result, the heart cannot deliver enough blood to the organs, potentially resulting in organ damage. It is likely a consequence of severe cuts, traumatic injuries, excessive bleeding, endometriosis, or placental abruption. Since this is an emergency, the amount of fluid or blood loss must be monitored to identify the level of shock.

Keep track of any clinical signs as well. The goal of this intervention is to identify alterations related to shock states. Tachycardia, lowered systolic blood pressure, constricted pulse pressure or immeasurable diastolic pressure , decreased or absence of urine output, diminished mental status or loss of consciousness , and cold and pale skin are all symptoms of shock. The level of hemorrhage is indeed life-threatening. Thus, to avoid serious consequences, healthcare providers must be aware of these signs.

Laboratory data also help medical providers in the diagnosis of other medical issues, the planning or evaluation of treatments, and the monitoring of diseases. This intervention aims to understand the probable origins of shock and the extent of organ involvement. Assist the patient in the prompt treatment of underlying problems. Also, aid the patient with his medical and surgical treatments. This intervention aims to improve systemic circulation as well as tissue and organ perfusion.

Administer oxygen through the proper method, if necessary. Gradually increasing the amount of oxygen administered improves systemic or tissue oxygenation. Administer blood or blood products as prescribed by the physician. Hypovolemic shock is a potentially fatal condition. Blood keeps the body temperature stable and transports oxygen and nutrients to all cells. If the blood volume becomes too low, the organs will be unable to function. Consequently, this therapeutic intervention aims to restore or maintain circulating volume and electrolyte balance quickly.

This method determines whether labor is present and the state of the fetus; the external system prevents cervical damage. Refrain the patient from drinking any liquids. This approach anticipates the necessity for emergency surgery. Urine output is an essential clinical indicator for determining renal function and blood volume status, particularly in critically ill multiple trauma patients or those suffering from shock.

This method tries to provide verifiable evidence of the amount of bleeding. Mild Placental Abruption If you have a mild abruption at 24 to 34 weeks , your doctor will likely recommend you go to the hospital for close monitoring. If tests show that you and the baby are well, you may receive medication to prolong your pregnancy for as long as possible.

You may need to stay in the hospital until you give birth, or if the bleeding stops, you may be able to go home. If you have a mild abruption at or near full term, your provider may recommend inducing labor or performing a C-section. If the heavy bleeding is uncontrollable, you may need a hysterectomy, which entirely removes the uterus. However, some of the risk factors are controllable. For example, you can stop smoking and avoid polluted air during pregnancy.

You can also take medication and watch your diet to prevent high blood pressure. Your doctor may recommend prenatal vitamins with folic acid to prevent pregnancy complications , including placental abruption. If you have any abdominal trauma or notice vaginal bleeding, talk to your doctor right away. Outlook and Prognosis The prognosis depends upon the severity of the placental abruption and how far along you are in the pregnancy when it occurs.

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The patient will produce an acceptable urine volume with normal specific gravity. The patient will exhibit his or her usual level of mentation. Placental Abruption Nursing Interventions Rationale Examine the patient for a history or the presence of disorders that could lead to hypovolemic shock. Hypovolemic shock is an emergency health condition in which the heart cannot pump enough blood to the body due to substantial blood or other fluid loss.

Many organs may stop working as a result of this type of trauma. Observe the patient thoroughly for persistent or substantial fluid or blood loss. When a person loses too much blood, the body experiences shock. As a result, the heart cannot deliver enough blood to the organs, potentially resulting in organ damage.

It is likely a consequence of severe cuts, traumatic injuries, excessive bleeding, endometriosis, or placental abruption. Since this is an emergency, the amount of fluid or blood loss must be monitored to identify the level of shock. Keep track of any clinical signs as well.

The goal of this intervention is to identify alterations related to shock states. Tachycardia, lowered systolic blood pressure, constricted pulse pressure or immeasurable diastolic pressure , decreased or absence of urine output, diminished mental status or loss of consciousness , and cold and pale skin are all symptoms of shock.

The level of hemorrhage is indeed life-threatening. Thus, to avoid serious consequences, healthcare providers must be aware of these signs. Laboratory data also help medical providers in the diagnosis of other medical issues, the planning or evaluation of treatments, and the monitoring of diseases. This intervention aims to understand the probable origins of shock and the extent of organ involvement.

Assist the patient in the prompt treatment of underlying problems. Also, aid the patient with his medical and surgical treatments. This intervention aims to improve systemic circulation as well as tissue and organ perfusion.

Administer oxygen through the proper method, if necessary. Gradually increasing the amount of oxygen administered improves systemic or tissue oxygenation. Administer blood or blood products as prescribed by the physician. Hypovolemic shock is a potentially fatal condition. Blood keeps the body temperature stable and transports oxygen and nutrients to all cells.

If the blood volume becomes too low, the organs will be unable to function. Consequently, this therapeutic intervention aims to restore or maintain circulating volume and electrolyte balance quickly. This method determines whether labor is present and the state of the fetus; the external system prevents cervical damage. Refrain the patient from drinking any liquids.

This approach anticipates the necessity for emergency surgery. Urine output is an essential clinical indicator for determining renal function and blood volume status, particularly in critically ill multiple trauma patients or those suffering from shock.

This method tries to provide verifiable evidence of the amount of bleeding. Instruct the patient to maintain a positive outlook on the fetal outcome. This intervention aims to promote mother-child attachment. Provide support and encouragement to the patient and her life partner. This method aids the patient in problem-solving, hampered by low self-esteem.

Nursing Care Plan for Placental Abruption 4 Acute Pain Nursing Diagnosis: Acute Pain related to the rapid separation of the placenta from the uterine wall, as well as the pain associated with labor contractions during the initial separation secondary to placental abruption as evidenced by a sharp, prickling sensation in the uterine fundus, along with uterine tenderness.

Desired Outcomes: The patient will report pain alleviation or control. The patient will adhere to the pharmaceutical regimen advised. The patient will discuss non-pharmacological means of relief. The patient will show the application of relaxation strategies and diversional activities. Ask the patient to rate her pain on a scale of 1 to 10 and describe the discomfort she is enduring. Pain duration, severity, and type of pain are some of these characteristics.

Pain scales can also assist clinicians in making an accurate diagnosis, developing a treatment strategy, and determining the effectiveness of treatment. This intervention also aids in determining whether an underlying illness or organ failure requires treatment. People who have an external locus of control may take little or no accountability for pain control.

Take note and analyze any differences from past reports of pain. Further assessment criteria, including location and quality, are critical in determining pain management therapies. Since patients may experience discomfort in regions other than the affected area, a piece of verbal information is essential. This intervention also seeks to prevent the underlying illness from worsening or complications from developing.

This strategy is helpful for the patient in describing her pain accurately. Chronic pain is frequently associated with nerve injury. The organs, muscles, and skin are all supplied by the same nerves. Furthermore, pain can have a variety of effects on vital signs. A natural response to pain, for example, is a rise in pulse rate, respiratory rate, and blood pressure. Take note of any pain reported by the patient and provide intervention as quickly as possible. Pain causes patients and their loved ones stress and suffering.

Pain can also raise heart rate and blood pressure, which can impair healing. Provide comfort measures, a quiet setting, and activities that are relaxing. A quiet environment also provides patients satisfaction and recovery. This method also promotes non-pharmacological pain management. As needed, administer analgesics. Analgesics are a type of medication used to alleviate pain. Encourage the patient to have enough rest. Chronic pain makes it difficult to achieve restful sleep, and a lack of sleep can cause patients to wake up in pain.

Sleeping allows the body to mend and rebuild itself. That is why it is necessary to help the patient achieve adequate rest and sleep. If the pain does not subside, refer the patient to a specialist. Pain management experts are clinicians who specialize in the diagnosis and treatment of individuals who are in pain.

A pain management professional creates a treatment regimen to relieve, decrease, or manage pain and assist patients in returning to daily activities without surgery or a significant reliance on medication. Desired Outcomes: The fetus will have normal FHR and beat-to-beat variability, with no alarming periodic alterations in reaction to placental abruption. The fetus will be successfully delivered with no congenital issues or severe ailments.

The patient will verbally communicate his or her comprehension of individual risks and the justifications for various interventions. The patient will follow instructions to protect himself and the fetus from harm. The patient will avoid avoidable harm or consequences. Placental abruption may affect FHR since it may cause the baby to become hypoxic and develop acidosis.

Therefore, it is necessary to note that fetal heart rate ranges typically between — bpm with average fluctuation, increasing in response to maternal exercise, fetal motion, and uterine contractions. Intermittent auscultation, a fetoscope or Doppler transducer, or continuous electronic fetal monitoring can all be used to determine the FHR. During the latent phase, FHR may be assessed every hour for low-risk clients, every 30 minutes for high-risk clients, and at any time during the bursting of the membranes, before and after ambulation, before and after anesthesia administration, after physical examination, if contractions are irregular, or if there are signs of placental abruption.

Examine the variability of FHR patterns and periodic variations in response to placental abruption. The baseline rate, baseline variability, episodic alterations, and periodic changes of the FHR must be assessed. Periodic alterations in the FHR caused by placental abruption, such as accelerations and decelerations, are just temporary. Thus, when the FHR fluctuates by more than 25 beats over the baseline, it indicates cord rupture or maternal hypotension.

Absent variability is associated with changes from baseline of fewer than six beats per minute for ten minutes and is often caused by placental abruption. If necessary, assist the patient with ultrasonography. Ultrasound is the primary and often only imaging modality to assess placental abruption. If placental abruption is present, ultrasonographic investigations can help promptly diagnose it as the cause of the bleeding. An ultrasonographic image of a placental abruption shows a retroplacental clot.

Prenatal records, as a clinical tool, provide prompts and care instructions for a wide variety of physical and psychosocial health factors during pregnancy. Management and Treatment Treatment depends upon the seriousness of the abruption, how far along the pregnancy is, and the amount of distress for the fetus. Mild Placental Abruption If you have a mild abruption at 24 to 34 weeks , your doctor will likely recommend you go to the hospital for close monitoring.

If tests show that you and the baby are well, you may receive medication to prolong your pregnancy for as long as possible. You may need to stay in the hospital until you give birth, or if the bleeding stops, you may be able to go home. If you have a mild abruption at or near full term, your provider may recommend inducing labor or performing a C-section. If the heavy bleeding is uncontrollable, you may need a hysterectomy, which entirely removes the uterus.

However, some of the risk factors are controllable. For example, you can stop smoking and avoid polluted air during pregnancy. You can also take medication and watch your diet to prevent high blood pressure. Your doctor may recommend prenatal vitamins with folic acid to prevent pregnancy complications , including placental abruption. If you have any abdominal trauma or notice vaginal bleeding, talk to your doctor right away.