Abruptio placentae vs placenta previa pain
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Placental abruption (abruptio placentae) and placenta previa are two closely related disorders that are easy to mix up even though they have very distinct pathways, treatments and interventions. To prepare for your NCLEX, nursing school exams and clinical, it’s important to understand the key differences between the two and nursing interventions for each. Show
Placental AbruptionWhat is placental abruption?The key point about placental abruption is that it occurs in a placenta that was implanted normally. Abruptions are classified from 0 to 3 based on the extent of the abruption.
Assessing for the presence of placental abruptionThe woman experiencing a placental abruption will typically have a sudden onset of symptoms, which typically include bleeding, pain, hypotension, tender uterus that is firm or even hard. It typically occurs after 20 weeks gestation and is a leading cause of maternal death. Lab tests will show that hemoglobin and hematocrit are reduced (especially in higher grade abruptions). Coagulation studies may show that DIC is present and a Kleihauer-Betke test may be done to assess for fetal blood in maternal circulation, though studies show it has poor sensitivity for diagnosing placental abruption. Who is at risk for placental abruption?
Treatment for placental abruptionTreatment for a placental abruption will depend on the severity of the abruption. If the abruption is mild and the mom is near her delivery date, the MD may induce labor mom and attempt a vaginal delivery. If the abruption is moderate to severe, then a cesarean section is likely once any coagulopathies have been addressed. Mom may also receive packed red blood cells to maintain a hematocrit above 30% and IV fluids to maintain volume. Coagulation tests will show if any abnormalities are present. Nursing interventions for placental abruption
 What is placenta previa?Placenta previa is a condition in which the placenta has implanted abnormally, either near or completely covering the cervix. It is classified based on location.
Who is at risk for placenta previa?
Assessing for the presence of placenta previaThe woman with placenta previa will often have insidious symptoms. Pain is typically not present (unless mom is in labor) and the uterus is soft though fundal height may be higher than expected. There will be bright red vaginal bleeding, and the fetus is not in distress. When assessing fetal position, the presentation is often abnormal and without engagement. Lab tests may show a decreased hemoglobin and hematocrit, depending on how heavily mom is bleeding. All moms who are bleeding will have the Kleihauer-Betke test to assess for fetal blood in circulation and, most likely, coagulation studies as well. Treatment for placenta previaMoms diagnosed with placenta previa will be on strict bedrest and most likely have a cesarean delivery due to the position of the placenta. If imminent delivery is needed and baby is premature, then betamethasone will be given to mom. MD will order CBC, Rh, possibly coagulation studies. The overall goal is to get mom as close to her due date as possible. Nursing interventions for placenta previa
Get this on audio in Podcast Episode 92.References Atkinson, A. L., Santolaya-Forgas, J., Matta, P., Canterino, J., & Oyelese, Y. (2015). The sensitivity of the Kleihauer-Betke test for placental abruption. Journal of Obstetrics and Gynaecology: The Journal of the Institute of Obstetrics and Gynaecology, 35(2), 139–141. https://doi.org/10.3109/01443615.2014.948398 Davidson, M. R., London, M. L., Ladewig, P. W., & Olds, S. B. (2008). Olds’ maternal-newborn nursing & women’s health across the lifespan (8th ed.). Upper Saddle River, N.J.: Pearson Prentice Hall. Deglin, Judith Hopfer, and April Hazard Vallerand. Davis’s Drug Guide for Nurses, with Resource Kit CD-ROM (Davis’s Drug Guide for Nurses). Philadelphia: F A Davis Co, 2009. Print. Hanson-Smith, B. (2010, April 16). High Risk Labor & Delivery. Maternal-Newborn Nursing. Lecture conducted from CSU Sacramento, Sacramento. Mayo Clinic. (n.d.). Placenta previa—Symptoms and causes. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/placenta-previa/symptoms-causes/syc-20352768 Philadelphia, T. C. H. of. (2014, August 23). Bleeding in Pregnancy/Placenta Previa/Placental Abruption [Text]. https://www.chop.edu/conditions-diseases/bleeding-pregnancyplacenta-previaplacental-abruption Which is painful Abruptio or previa?In the case of placenta previa, the placenta is seen near or over the cervix in the lower section of the uterus. Typically, patients with placenta abruption face painful contractions and bleeding, while those with placenta previa sense painless bleeding.
Is placental abruption painful?The main symptom of placental abruption is vaginal bleeding. You also may have pain,contractions, discomfort and tenderness or sudden, ongoing belly or back pain. Sometimes, these symptoms may happen without vaginal bleeding because the blood is trapped behind the placenta.
Is Abruptio placenta painless?The typical clinical presentation of abruptio placenta is sudden onset of abdominal (uterine) pain and vaginal bleeding. Other symptoms are associated with severity of bleeding. However, in nearly 20% of cases, placenta abruptions are concealed and, therefore, do not present with vaginal bleeding.
What does abdominal pain from placental abruption feel like?What does placental abruption feel like? You may experience sudden or sharp pain, cramping, or tenderness in your lower pelvic region or back during a placental abruption. You could also feel your baby move less. You should discuss these symptoms with your healthcare provider immediately.
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