Your client is a 31-year-old multigravida who is in active labor at 39 weeks’ gestation. She has had no prenatal care, but she knows that her last menstrual period was on July 7, 2014. Based on the client’s assessment, you plan her care. The fetus is deemed high-risk for shoulder dystocia and may not be viable at delivery. A placental augmentation is required and a fetal monitor may be inserted during delivery.
The clinical picture is based on the extent of placental separation and the amount of bleeding that follows. A partial detachment occurs when only part of the placenta separates from the uterine wall, while a complete placental detachment occurs when the entire placenta has detached. You may also observe bleeding that is either apparent or concealed.
Ultrasound can be a useful tool in assessing placental detachment. Ultrasound is the primary imaging modality for this diagnosis. Ultrasound images can identify retroplacental clot. Ultrasounds can be helpful for recognizing the signs and symptoms of placental detachment, and interpreting results is crucial to preventing miscarriage.
If you suspect that placental detachment is happening, you should immediately take the patient to the maternity ward or the intensive care unit. Depending on the severity of placental separation, your patient may need to undergo a cesarean section to deliver the baby. But if your patient’s hemodynamics are stable, you should try vaginal delivery. You should prepare the nurse for fetal distress and hemodynamic shock. You should also have access to an intravenous line and a large-bore catheter.
The patient is unable to breathe independently and is not talking. She appears to be holding her head down. Rebecca’s husband also reports that she is whispering to the nurse. During the visit, Rebecca holds her head down and is unable to speak clearly. The ultrasound images show normal fetal heart tones, but Rebecca is having difficulty expressing her own thoughts. She denies any pain, but seems to be experiencing abdominal pain.
If a mother’s blood pressure drops suddenly, she should contact her health care provider immediately. The nurse should place the mother in the Trendelenburg position, administer oxygen via a face mask, and document the findings. She should also reposition the mother if she experiences a sudden change in her blood pressure. If the mother’s blood pressure increases, she should tell the mother that bed rest is needed to conserve oxygen.
Retroplacental clots are another symptom of placental detachment. These clots are dark and adherent and distinguish from the soft, non-adherent clots present during physiologic placental separation in the third stage of labor. In rare cases, the placenta may separate completely or remain attached to the uterine wall. If the clots are permanent, the mother may need to undergo delivery.
What data indicates to the nurse that placental clots are forming in a pregnant woman? What are the risks of this occurrence? During a routine prenatal visit, the nurse monitors for any signs of coagulation. She also checks for any signs of uterine rupture, and if any other conditions are present, the nurse must make a decision.