The placenta prematurely separates from the uterine wall after the 20th week of gestation.
A severe sudden onset of abdominal pain occurs.
Dark red vaginal bleeding may be present; however, if separation is in the center of the placenta, then blood may be trapped between the placenta and decidua, concealing the hemorrhage. A concealed hemorrhage occurs in about 10% of patients with resulting uterine tenderness and pain.
A rigid uterus, or board-like abdomen may be noted upon assessment. Other patients may present with uterine tenderness accompanied with pain.
Frequent uterine contractions or ones with no relaxation in between may occur. Hypertonic uterine activity will lead to poor blood and oxygen exchange for the fetus.
Preparing for delivery of the fetus should be done as soon as possible. Vaginal delivery is preferred if the fetus is healthy and stable and if the presenting part is in the pelvis.
Increased risks for the neonate include preterm birth, intrauterine growth restriction, hypoxia, anoxia, neurological injury, and fetal death related to hemorrhage.
Due to possible mixing of maternal and fetal blood, sensitization can occur if the fetus is Rh positive. The mother may be given Rhogam if she is Rh negative.
Excessive bleeding places the mother at risk for hypovolemic shock. It is important to note that during pregnancy, signs of shock may not be present until 25-30% of maternal blood loss has occurred. Be sure to closely monitor vital signs, maintain IV access with a large bore IV, and provide fluids, blood products, and oxygen as prescribed.
Monitor fetal heart rate as signs of possible decline include prolonged fetal bradycardia, repetitive late decelerations, or decreased short-term variability.
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