Maternity Nursing: Intrapartum Q 14
A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?
A. Absence of abdominal pain
B. A soft abdomen
C. Uterine tenderness/pain
D. Painless, bright red vaginal bleeding
Correct Answer: C. Uterine tenderness/pain
In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding.
Option A: Placental abruption occurs when there is a compromise of the vascular structures supporting the placenta. In other words, the vascular networks connecting the uterine lining and the maternal side of the placenta are torn away. These vascular structures deliver oxygen and nutrients to the fetus.
Option B: The abdomen will feel hard and board like on palpation as the blood penetrates the myometrium and causes uterine irritability. Disruption of the vascular network may occur when the vascular structures are compromised because of hypertension or substance use or by conditions that cause stretching the uterus. The uterus is a muscle and is elastic whereas the placenta is less elastic than the uterus. Therefore, when the uterine tissue stretches suddenly, the placenta remains stable and the vascular structure connecting the uterine wall to the placenta tears away.
Option D: 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.