Placental abruption (also known as abruptio placenta or the premature separation of the placenta) occurs when the placenta appears to have been implanted correctly but begins to separate suddenly, which results in bleeding. It may be partial or total; it may be marginal (separating at the edges) or central (separating in the middle). The separation generally occurs late in pregnancy, even as late as during the first or second stage of labor.
The primary cause of placental abruption is unknown, but certain predisposing factors are high parity, advanced maternal age, a short umbilical cord, chronic hypertensive disease, hypertension of pregnancy, direct trauma, vasoconstriction from cocaine or cigarette use, and thrombophilic conditions that lead to thrombosis formation. It can also be caused by maternal folate deficiency and chorioamnionitis or the infection of the fetal membranes and fluid.
Bleeding accompanied by abdominal or low back pain is typical of a placental abruption. Most or all of the bleeding may be concealed behind the placenta. Obvious dark red vaginal bleeding occurs when blood leaks past the edge of the placenta. The client’s uterus is tender and unusually firm or boardlike. Frequent, cramp-like uterine contractions often occur.
The treatment of choice, immediate cesarean birth, is performed because of the risk for maternal shock, clotting disorders, and fetal death. Blood and clotting factor replacement may be needed because of DIC.
Table of contents
- Nursing Care Plans and Management
- See also
- References and Sources
Nursing Care Plans and Management
The nursing care plan and management for patients with placental abruption focus on timely recognition, assessment, and intervention. This includes monitoring vital signs, uterine contractions, and fetal heart rate, as well as assessing for signs of maternal and fetal distress. Immediate actions may involve initiating emergency measures, such as administering oxygen, establishing intravenous access, and preparing for an emergency cesarean section if necessary.
Nursing Problem Priorities
The following are the nursing priorities for patients with placental abruption:
- Monitor maternal vital signs and assess for signs of shock
- Continuous fetal monitoring to assess fetal well-being
- Administer oxygen therapy as needed
- Administer intravenous fluids and blood products as necessary
- Monitor and manage pain
- Assess and manage any associated bleeding
- Prepare for potential emergency cesarean section
Assess for the following subjective and objective data:
- Vaginal bleeding (bright red)
- Abdominal pain or tenderness
- Uterine contractions (frequent and intense)
- Fetal distress (rapid heart rate, decreased movement)
- Back pain
- Uterine rigidity
- Maternal hypovolemic shock (lightheadedness, rapid heartbeat, low blood pressure)
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with placental abruption based on the nurse’s clinical judgment and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- The client will demonstrate vital signs within normal limits, a normal capillary refill, and warm, dry skin.
- The client will maintain strong and palpable peripheral pulses and adequate urine output.
- The client will verbalize the absence of abdominal pain.
- The client will display and maintain an average level of consciousness.
- The client will regain vital signs within the normal range.
- The client will be able to verbalize understanding of the disease process, risk factors, and treatment plan.
- The fetal heart rate will be within the normal range.
- The client will exhibit an adequate amount of urine output with normal specific gravity.
- The client will display the usual level of mentation.
- The client will report relief or control of pain.
- The client will follow the prescribed pharmacological regimen.
- The client will verbalize nonpharmacological methods that provide relief.
- The client will demonstrate the use of relaxation skills and diversional activities as indicated.
- The fetus will be free of complications associated with placental abruption.
- The client will modify the environment, as indicated, to enhance safety and use resources appropriately.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients with placental abruption may include:
1. Promoting Effective Tissue Perfusion
Placental abruption occurs when the maternal vessels tear away from the placenta, and bleeding occurs between the uterine lining and the maternal side of the placenta. As the blood accumulates, it pushes the uterine wall and placenta apart. The placenta is the fetus’s source of oxygen and nutrients and the way the fetus excretes waste products. Diffusion to and from the maternal circulatory system is essential to maintaining these life-sustaining functions of the placenta. When accumulating blood causes separation of the placenta from the maternal vascular network, these vital functions of the placenta are interrupted (Rowe, 2022).
Assess the client’s vital signs, oxygen saturation, and skin color.
As with any hypovolemic condition, blood pressure drops as the pulse increases. With placental abruption, a relatively stable client may rapidly progress to a state of hypovolemic shock if the origin of the hemorrhage is not identified immediately (Deering & Smith, 2018). Low oxygen saturation levels and cyanosis of the skin or lips can indicate hypovolemia.
Monitor for restlessness, anxiety, hunger, and changes in level of consciousness (LOC).
These conditions may indicate decreased cerebral perfusion. Changes in the client’s level of consciousness may reflect diminished perfusion to the central nervous system. As the client’s condition leads to hypovolemic shock, the client’s level of consciousness progresses from an alert to an obtunded state (Deering & Smith, 2018).
Monitor the intake and output accurately.
An external or internal hemorrhage may cause dehydration. Decreased renal perfusion and renal failure may occur because of vasoconstriction, thereby decreasing urine output.
Monitor fetal heart sounds and rates continuously.
Signs of possible fetal jeopardy include prolonged fetal bradycardia, repetitive, late decelerations, and decrease short-term variability. The absence of fetal heart sounds may occur when the abruption progresses to the point of fetal death (Deering & Smith, 2018).
Assess uterine contractions and palpate the uterus.
Contractions and uterine hypertonus are part of the classic triad observed with placental abruption. Uterine activity is a sensitive marker of the placental abruption and, in the absence of vaginal bleeding, should suggest the possibility of an abruption, especially after some form of trauma or in a client with multiple risk factors. The client’s fundal height may increase rapidly because of an expanding intrauterine hematoma (Deering & Smith, 2018). The uterus is often firm and may be rigid and tender. If a substantial volume of blood has extravasated into the myometrium, it can become “woody hard,” with fetal parts no longer palpable (Ananth & Kinzler, 2022). If blood infiltrates the uterine musculature, Couvelaire uterus or uteroplacental apoplexy, forming a hard, boardlike uterus occurs.
Assess the level and characteristics of abdominal pain.
The severity of abdominal pain is a useful marker of the severity of the abruption and, in turn, maternal and fetal/newborn risk of morbidity and mortality (Ananth & Kinzler, 2022). The bleeding may be accompanied by abdominal or low back pain or a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. If labor begins with the separation, each contraction will be accompanied by pain over and above the pain of the contraction.
Assess skin color, moisture, turgor, and capillary refill.
The changes in these parameters may reflect diminished circulation and hypoxia. Capillary refill time is a useful and rapid metric in determining the intravascular volume status of the client. Markers of reduced perfusion include delayed capillary refill time, dry mucous membranes, poor skin turgor, and absence of diaphoresis (McGuire et al., 2022).
Assess the extent of bleeding.
Obvious dark red vaginal bleeding occurs when blood leaks past the edge of the placenta. Vaginal bleeding is present in 80% of clients diagnosed with placental abruption. However, remember that 20% of abruptions are associated with a concealed hemorrhage, and the absence of vaginal bleeding does not exclude a diagnosis of placental abruption. The bleeding may be profuse and come in “waves” as the client’s uterus contracts. A fluid color of port wine may be observed when the membranes rupture in association with the hemorrhage (Deering & Smith, 2018).
Assess the client’s lower extremities for skin characteristics and peripheral pulses.
Reduced peripheral circulation often leads to skin and underlying tissue changes and delayed healing. Vasoconstriction or extreme blood loss may lead to partial or complete obliteration of a vessel with diminished perfusion to surrounding tissues.
Obtain specimens for laboratory and diagnostic testing.
Laboratory findings correlate with the degree of placental separation. The fibrinogen level is the test that correlates best with the severity of bleeding, presence of overt DIC., and the need for transfusion of multiple blood products.
Position the client in a lateral or left side-lying position.
Place the client in a lateral, not supine, position to prevent pressure on the vena cava and additional interference with fetal circulation. Fetal prognosis depends on the extent of the placental separation and the degree of fetal hypoxia; therefore, the delivery of oxygen to the fetus is essential.
Avoid performing a vaginal examination or any procedures that may disturb the injured placenta.
Do not perform a digital examination on a pregnant client with vaginal bleeding without first ascertaining the location of the placenta. Before a pelvic examination can be safely performed, an ultrasonographic examination should be performed to exclude placenta previa. If placenta previa is present, a pelvic examination, either with a speculum or with a bimanual examination, may initiate profuse bleeding (Deering & Smith, 2018).
Educate the client and significant others about prompt recognition and report of signs and symptoms of thrombosis or DIC.
Disseminated intravascular coagulation (DIC) is an acquired disorder of blood clotting in which the fibrinogen level falls below effective limits. Early symptoms include easy bruising or bleeding from an intravenous site. The client may also bleed from her mouth, nose, and incisions. Prompt recognition and reporting to the healthcare provider may prevent the worsening of the condition and future complications.
Administer oxygen by mask.
Administer continuous high-flow supplemental oxygen to the mother. Maternal oxygen administration can be used to attempt to lessen fetal distress and avoid fetal anoxia by increasing the available oxygen from the mother.
Administer intravenous fluids as indicated.
Obtain intravenous access using two large-bore needles and institute crystalloid fluid resuscitation. If needed, perform aggressive fluid resuscitation to maintain adequate perfusion (Gaufberg & Lo, 2021).
Administer blood and blood products as ordered.
Blood and clotting factor replacement may be needed because of DIC. Intravenous administration of fibrinogen or cryoprecipitate (which contains fibrinogen) can be used to elevate the client’s fibrinogen level prior to and concurrently with surgery.
2. Managing Hemorrhage and Preventing Shock
The client diagnosed with placental abruption may present with hypovolemic shock, with or without vaginal bleeding, because a concealed hemorrhage may be present. Hypovolemic shock is a circulatory collapse due to inadequate intravascular blood volume. This condition leads to a hemodynamic and metabolic collapse and the failure of the circulatory system to maintain adequate perfusion of vital organs resulting in decreased oxygenation of the tissues and reduced nutrient delivery (Pacagnella & Borovac-Pinheiro, 2019).
Assess for history or presence of conditions leading to hypovolemic shock.
The condition may deplete the body’s circulating blood volume and the ability to maintain organ perfusion and function. Eliciting any history of trauma, such as assault, abuse, or motor vehicle accident, is important. A quick review of the client’s prenatal course, such as a known history of placenta previa, may help lead to the correct diagnosis. The client should also be asked if she has had a placental abruption in a previous pregnancy (Deering & Smith, 2018).
Monitor for persistent or heavy fluid or blood loss.
The amount of fluid or blood loss must be noted to determine the extent of the shock. The amount of vaginal bleeding correlates poorly with the degree of placental separation. A severe abruption may be associated with mild or clinically insignificant vaginal bleeding when a large volume of blood is retained behind the placenta (Ananth & Kinzler, 2022).
Assess vital signs and tissue and organ perfusion.
Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, is taken (McGuire et al., 2022). When considering the general cut-off points for vital signs in pregnant women, it is common to observe a delayed diagnosis of hypovolemic shock. It often occurs due to reliance on blood pressure for the diagnostic rather than signs of decreased peripheral perfusion. Classically, the clinical signs following a hypovolemic shock are hypotension, tachycardia, and oliguria, but other signs can also be present, such as pallor, agitation, dyspnea, sweating, and pulsus paradoxus (Pacagnella & Borovac-Pinheiro, 2019).
Measure intake and output and record urine-specific gravity.
Fluid balance indicates circulatory status and replacement needs. Excessive or prolonged blood loss requires evaluation and ongoing assessments to continually determine and provide prompt and appropriate intervention.
Monitor the client’s biophysical profile (BPP).
BPP can be used to help evaluate clients with chronic abruptions who are being managed conservatively. A BPP score of less than 6 (maximum of 10) may be an early sign of fetal compromise. A modified BPP (nonstress test with amniotic fluid index) is sometimes used for monitoring in this situation (Deering & Smith, 2018).
Monitor uterine contractions and fetal heart rate with an external monitor.
The physical examination includes palpation of the uterus. The uterus is palpated for tenderness, consistency, and frequency and duration of uterine contractions. Continuous electronic fetal monitoring is initiated to identify prolonged bradycardia, decreased variability, and the presence of late decelerations (McGuire et al., 2022).
Review laboratory and diagnostic test results.
Blood work, including a CBC, clotting studies, and BUN, provides baseline parameters to evaluate the client’s status changes. A blood type and Rh will be obtained if a blood transfusion is necessary (McGuire et al., 2022). Pregnancy is associated with hyperfibrinogenemia; therefore, modestly depressed fibrinogen levels may represent significant coagulopathy (Deering & Smith, 2018).
Verify that orders for blood typing and crossmatch have been implemented.
The client should have her blood typed and at least two units of packed RBCs crossmatched in the event she requires a transfusion. The blood Rh is important to determine because clients who are Rh-negative require Rh immune globulin to prevent isoimmunization, which could affect future pregnancies (Deering & Smith, 2018).
Measure maternal blood loss by weighing perineal pads and saving any tissue that has passed.
The direct measurement of blood is probably the most ancient method for reporting hemorrhage. Edhi et. al, in their research to study the reasons for bleeding and correct bleeding control, concluded that assessment of the risk factor and estimation of blood loss are necessary to prevent this fatal condition. According to other studies, the methods that can be implemented with the least equipment and education revolve around direct measurement and weighing (Golmakani et al., 2015).
Provide emotional support to the woman and her support person. Provide honest information as much as possible.
Women expect to have their distress acknowledged and validated, with healthcare staff showing empathy, maintenance of privacy, and referral for psychological support if needed. Keeping the client informed throughout their stay and providing written information can also improve the client’s experience (See et al., 2019).
Position the client in a supine position.
Consider laying the client down to help elevate the extremity and prepare for the shock position. Place the client in the supine position with legs elevated approximately 8-12 inches.
Administer oxygen by an appropriate route.
Optimize tissue oxygenation through an oxygen mask at 10L/min. Loss of intravascular volume will result in vasoconstriction to maintain systemic pressure with a consequent reduction in cardiac output. If cardiac output falls below the normal range, it will result in decreased delivery of oxygen and nutrient to the tissues (Pacagnella & Borovac-Pinheiro, 2019).
Administer blood or blood products as indicated.
Transfusion of blood products is necessary when the blood loss is significant and continuous, causing deterioration of vital hemodynamic parameters, which become unstable. When there is a need to replace 50% of blood volume in two hours, when there is a replacement of four or more packed RBCs, or when there is hemodynamic instability in the period of profuse bleeding, it is indicated to initiate protocols for massive transfusion (Pacagnella & Borovac-Pinheiro, 2019).
Administer intravenous fluids as indicated.
See Pharmacologic Management
Administer oxytocin as indicated.
See Pharmacologic Management
Keep client on NPO to prepare for surgery.
The client should be restricted to nothing by mouth (NPO) if emergent delivery is a possibility. Cesarean birth is often necessary for fetal and maternal stabilization (Deering & Smith, 2018).
Prepare the client and assist with a cesarean birth and other surgical procedures as necessary.
While cesarean birth facilitates rapid delivery and direct access to the uterus and its vasculature, it can be complicated by the client’s coagulation status. If bleeding cannot be controlled after delivery, a cesarean hysterectomy may be required to save the client’s life. Before proceeding to hysterectomy, other procedures, including correction of coagulopathy, ligation of the uterine artery, administration of uterotonics, packing of the uterus, and other techniques to control hemorrhage, may be attempted (Deering & Smith, 2018).
Arrange a transfer to the intensive care unit (ICU) as appropriate.
Transfer of the client to an ICU may be necessary before or after delivery if the client is hemodynamically unstable, such as if shock develops and requires invasive central monitoring or if operative complications are encountered (Deering & Smith, 2018).
3. Providing Pain Relief
In acute severe placental abruption, high-pressure arterial hemorrhage in the central area of the placenta extensively dissects through the placental-decidual interface and causes complete or partial placental separation. A small proportion of these cases are caused by sudden mechanical events that can strain the interface between the pliable myometrium and the inelastic placenta. Severe maternal trauma is associated with a sixfold increase in abruption (Ananth & Kinzler, 2022). Uterine hyperstimulation may occur with little or no break in uterine activity between contractions. These contractions are painful and palpable.
Assess the level of pain and referred pain as appropriate.
The client experiences a sharp, stabbing pain high in the uterine fundus as the initial separation occurs. If labor begins with the separation, each contraction will be accompanied by pain over and above the pain of the contraction. Tenderness can be felt on uterine palpation.
Note the client’s locus of control.
The locus of control is a concept defined as the degree to which people believe their health is controlled by internal or external factors. People with an internal locus of control are convinced that they can control their own destiny, feel responsible for their lives and their behavior, and they are capable of internal growth and improvement through effort and the development of their abilities (Espinosa et al., 2022). Individuals with an external locus of control may take little or no responsibility for pain management.
Note and investigate changes from previous reports of pain.
Identifying changes in the characteristics of pain may help rule out the worsening of underlying conditions or the development of complications. The abruption may have gotten worse if there is an increase in the pain level and may warrant an emergent birth.
Monitor skin color and vital signs.
Elevations in heart rate may indicate increased discomfort or may occur in response to fever and inflammatory processes. Fever can also increase the client’s discomfort.
Evaluate the effectiveness of pain control.
Pain perception and pain relief are subjective. Thus pain management is best left to the client’s discretion. If the client cannot provide input, the nurse should observe physiological and nonverbal signs of pain and administer medications regularly.
Encourage verbalization of feelings about the pain.
Fears and concerns can increase muscle tension and lower pain perception threshold. Support may enable the client to begin exploring and dealing with the reality of her situation. The client may need time to identify feelings and more time to express them.
Acknowledge the client’s description of pain and convey acceptance of the client’s response to pain.
Pain is a subjective experience and cannot be felt by others. It is important for healthcare providers to explore and acknowledge client concerns about their presentation. A client who perceives that they have had a negative experience is more likely to be dissatisfied with their care. This may be regardless of the appropriateness of their treatment according to best practice and may be due to a mismatch between the client’s expectations and clinician beliefs (See et al., 2019).
Provide comfort measures, a quiet environment, and calm activities.
The ability to release tension is vital to the client’s “tool kit.” Relaxation techniques require concentration, thus occupying the mind while reducing muscle tension. Promoting relaxation is basic to all other methods of pain management and birth preparation. The nurse should adjust the client’s environment and help her with general comfort measures. Heat can be applied with a warm blanket, and the client may appreciate a cool cloth on the face. Favorite music or relaxation recordings may divert the client’s attention from pain.
Schedule activities and encourage adequate rest periods.
Fatigue reduces pain tolerance and the client’s ability to use coping skills. Many women are tired when labor begins because sleep during late pregnancy is difficult. The active fetus, frequent urination, and shortness of breath when lying down all interrupt sleep.
Administer pain medications as indicated.
See Pharmacologic Management
4. Preventing Fetal Injury
Placental abruption is a leading cause of stillbirth and neonatal mortality. Placental separation is thought to be due to changes in placental vasculature, thrombosis, and reduced placental perfusion. A genetic basis for the placental abruption has been speculated as the cause for these changes. There is a four to six times higher risk of premature delivery when there is a diagnosis of placental abruption. Premature delivery increases the risk of infant mortality.
Assess fetal heart rate patterns.
Signs of fetal jeopardy include prolonged bradycardia, repetitive, late decelerations, and decreased short-term variability. Attach a fetal heart rate and uterine contraction monitor to the mother to detect the fetal heart rate response to fetal movement (nonstress test). When the fetus moves, the FHR should increase approximately 15 beats/min and remain elevated for 15 seconds. It should decrease to its average rate again as the fetus quiets. If no increase in beats per minute is noticeable in fetal movement, further testing may be necessary to rule out poor oxygen perfusion of the fetus.
Review ultrasound results for intrauterine growth restriction and weigh the neonate accurately after birth.
If the abruption is chronic, ultrasound results may reveal intrauterine growth restriction as a result of developing placental ischemia. Antepartum hemorrhage may frequently result in low birth weight babies. This can be the effect of preterm labor or repeated small events of hemorrhage causing chronic placental insufficiency and fetal growth retardation (Jharaik et al., 2019).
Performing APGAR scoring five minutes after the birth of the neonate.
In a study, predictors of fetal outcome include an Apgar scoring at five minutes. Neonates that receive delayed intervention (more than an hour after diagnosis) were more likely to have Apgar scores <7 at five minutes than neonates receiving the early intervention (within an hour). Of eight cases with Apgar less than 3, seven mortalities were noted, and one neonate has grade 3 hypoxic-ischemic encephalopathy due to preterm birth (Mehta et al., 2021).
Monitor the neonate for signs of shock.
Complete placental abruption occurs when the placenta totally detaches, a situation that is incompatible with fetal survival. Infants of mothers diagnosed with placental abruption who survive must be closely monitored for signs of blood loss and shock (Kenner et al., 2019).
Initiate early interventions as indicated.
Neonates born to mothers receiving an early intervention had shorter intensive care unit stays and better Apgar scores compared to those born to mothers receiving a delayed intervention. Interventions include correction of anemia, thrombocytopenia, coagulation disorders, treatment of correctable risk factors, and delivery (Mehta et al., 2021).
Educate the mother about the effects of smoking and cocaine abuse on the fetus.
Two of the most notable correctable factors are smoking and cocaine abuse. Education about the risks of these behaviors and about cessation or rehabilitation programs may help prevent abruptions. The perinatal mortality rate of infants born to women who smoke and have an abruption is increased (Deering & Smith, 2018).
Instruct the mother to strenuous activities and encourage bedrest during admission as appropriate.
This approach ensures that the mother and fetus can be closely monitored and, if needed, rapidly treated. The modified activity involves refraining from any activity that increases intra-abdominal pressure for a long period of time. The mother should also be advised to refrain from sexual intercourse (Dulay, 2020).
Administer corticosteroids as ordered.
See Pharmacologic Management
Administer blood and blood products as ordered.
See Pharmacologic Management
Assist in vaginal delivery or cesarean birth as indicated.
The ability of the client to undergo vaginal delivery depends on her remaining hemodynamically stable. Cesarean birth is often necessary for fetal and maternal stabilization. While cesarean birth facilitates rapid delivery and direct access to the uterus and its vasculature, it can be complicated by the client’s coagulation status (Deering & Smith, 2018).
5. Administer Medications and Provide Pharmacologic Support
The medications used for patients with placental abruption depend on the severity of the condition and the clinical presentation. In cases of significant bleeding, intravenous fluids are administered to maintain hemodynamic stability. Blood transfusions or blood products may be necessary to replace lost blood and restore adequate oxygen-carrying capacity. Medications such as oxytocin or other uterine stimulants may be used to manage uterine contractions and control bleeding. Corticosteroids may be used to promote fetal lung maturation and reduce the risk of respiratory distress syndrome (RDS) in premature infants Pain management medications, such as analgesics or opioids, may also be prescribed to alleviate discomfort.
The main goal of intravenous fluid management is to improve cardiac output to maintain global blood flow and increase tissue perfusion and oxygen availability for cellular respiration. A classic strategy for the use of crystalloids in hemorrhagic shock is the “three to one” rule (3 ml of crystalloid for every 1 ml of blood loss). A maximum fluid volume of 3.5 ml is recommended in the first-line measures, administered in well-defined, rapidly infused boluses of 500 ml. The preference is for the administration of warmed crystalloids (Pacagnella & Borovac-Pinheiro, 2019).
Blood and blood products
Most clients diagnosed with placental abruption, whether early or late, required blood transfusion in the form of packed RBCs. Several required platelet and plasma transfusion for correction of coagulopathies. It is important to note that while transfusion of packed RBCs is not significant between clients receiving early and delayed care, platelet and plasma transfusion was found to be significantly higher in clients receiving delayed care which may be due to the fact that these clients were more likely to have coagulopathy (Mehta et al., 2021).
Oxytocin, a synthetic hormone, is usually administered to patients with placental abruption to induce or augment uterine contractions. It helps to control bleeding and promote the expulsion of the placenta. By stimulating the uterus, oxytocin can help reduce the risk of postpartum hemorrhage, a potential complication of placental abruption.
Corticosteroids should be considered to accelerate fetal lung maturity if the gestational age is <34 weeks. Corticosteroids may also be given if the pregnancy is late preterm (34 to 36 weeks), the mother has not previously received any corticosteroids, and the risk of delivery in the late preterm period is high (Dulay, 2020).
Analgesics are systemic drugs that reduce pain without the loss of consciousness. When pharmacological pain relief is administered, safety protocols must be implemented such as raising the side rails and maintaining close observation.
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other care plans related to the care of the pregnant mother and her baby:
- Abortion (Termination of Pregnancy) | 8 Care Plans
- Cervical Insufficiency (Premature Dilation of the Cervix) | 4 Care Plans
- Cesarean Birth | 11 Care Plans
- Cleft Palate and Cleft Lip | 7 Care Plans
- Gestational Diabetes Mellitus | 8 Care Plans
- Hyperbilirubinemia (Jaundice) | 4 Care Plans
- Labor Stages, Induced, Augmented, Dysfunctional, Precipitous Labor | 45 Care Plans
- Neonatal Sepsis | 8 Care Plans
- Perinatal Loss (Miscarriage, Stillbirth) | 6 Care Plans
- Placental Abruption | 4 Care Plans
- Placenta Previa | 4 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 5 Care Plans
- Prenatal Hemorrhage (Bleeding in Pregnancy) | 9 Care Plans
- Preeclampsia and Gestational Hypertension | 6 Care Plans
- Prenatal Infection | 5 Care Plans
- Preterm Labor | 7 Care Plans
- Puerperal & Postpartum Infections | 5 Care Plans
- Substance Abuse in Pregnancy | 9 Care Plans
References and Sources
Recommended journals, books, and other interesting materials to help you learn more about placental abruption nursing care plans and nursing diagnosis:
- Ananth, C. V., & Kinzler, W. L. (2022, July 12). Acute placental abruption: Pathophysiology, clinical features, diagnosis, and consequences. medilib | . Retrieved August 24, 2022.
- Deering, S. H., & Smith, C. V. (2018, November 30). Abruptio Placentae Clinical Presentation: History, Physical Examination. Medscape Reference. Retrieved August 24, 2022.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.
- Dulay, A. T. (2020, October). Perinatal outcomes in placental abruption | IMSEAR. Pesquisa .bvsalud .org. Retrieved August 30, 2022.
- Espinosa, M., Artieta-Pinedo, I., Paz-Pascual, C., Bully-Garay, P., & Garcia-Alvarez, A. (2022, June 28). Attitudes toward medicalization in childbirth and their relationship with locus of control and coping in a Spanish population. BMC Pregnancy and Childbirth, 22(529).
- Gaufberg, S. V., & Lo, B. M. (2021, January 8). Emergent Management of Abruptio Placentae: Overview, History, Physical Examination. Medscape Reference. Retrieved August 24, 2022.
- Golmakani, N., Khaleghinezhad, K., Dadgar, S., Hashempor, M., & Baharian, N. (2015, July-August). Comparing the estimation of postpartum hemorrhage using the weighting method and National Guideline with the postpartum hemorrhage estimation by midwives. NCBI. Retrieved August 24, 2022.
- Jharaik, H., Sharma, A., Sharma, R., & Sharma, K. (2019). Comparison of placenta previa and placental abruption and its maternal and perinatal outcome. International Journal of Clinical Obstetrics and Gynaecology, 3(4), 161-166.
- Kenner, C., Altimier, L., & Boykova, M. V. (Eds.). (2019). Comprehensive Neonatal Nursing Care. Springer Publishing Company.
- Leifer, G. (2018). Introduction to Maternity and Pediatric Nursing. Elsevier.
- McGuire, D., Gotilib, A., & King, J. (2022, April 21). Capillary Refill Time – StatPearls. NCBI. Retrieved August 24, 2022.
- Mehta, S. P., Deshmukh, P. Y., & Bawa, A. K. (2021, April). Placental abruptione: impact of early treatment on maternal and fetal outcomes. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(4), 1533-1539.
- Pacagnella, R. C., & Borovac-Pinheiro, A. (2019, November). Assessing and managing hypovolemic shock in puerperal women. Best Practice & Research Clinical Obstetrics & Gynaecology, 61, 89-105.
- Rowe, C. (2022, April 1). Placental Abruption – StatPearls. NCBI. Retrieved August 24, 2022, from
- See, S. Y., Blecher, G. E., Craig, S. S., & Egerton-Warburton, D. (2019, December 01). Expectations and experiences of women presenting to emergency departments with early pregnancy bleeding. Emergency Medicine Australasia, 32(2), 281-287.
- Silbert-Flagg, J., & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Wolters Kluwer.