Maternity Nursing: Intrapartum Q 16
An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:
A. Complete bed rest for the remainder of the pregnancy.
B. Delivery of the fetus.
C. Strict monitoring of intake and output.
D. The need for weekly monitoring of coagulation studies until the time of delivery.
Correct Answer: B. Delivery of the fetus.
The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.
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. 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.
Option C: 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. These laboratory values will not aid in the diagnosis of placental abruption but will provide baseline data against which to evaluate the patient’s condition over time.
Option D: Women classified with a class 1 or mild placental abruption and no signs of maternal or fetal distress and a pregnancy less than 37 weeks gestation may be managed conservatively. These patients are usually admitted to the obstetrical unit for close monitoring of maternal and fetus status. Intravenous access and blood work for type and crossmatch is part of the plan of care. The maternal-fetal dyad will continue to be monitored until there is a change in condition or until fetal maturity is reached.