Abruption Management Notes 26/03

Acute Assessment of Abruption

  • Consultation Required: Immediate consultation with the obstetric team is critical upon detection of an abruption, regardless of size.

  • Signs of Abruption:

    • The abruption usually involves bleeding that can be apparent, concealed, or partial.

    • It differs from placenta previa, which occurs without prior history.

  • Initial Evaluation:

    • Check blood pressure and hemodynamic status; blood loss can lead to shock and decreased blood pressure.

    • Determine trauma history that may correlate with the abruption case.

  • Pain Assessment:

    • Look for subtle pain; it may indicate deterioration.

Priorities During Admission

  • Consent: Ensure the patient understands the procedures being undertaken.

  • Gestational Age Consideration: Depending on the pregnancy stage, various teams will be involved (surgical, neonatal).

  • Transfer Coordination: Consider effective transport methods to the secondary or tertiary unit, ensuring patient stability by positioning in left lateral or lying down.

  • Support Systems: Identify immediate personnel available to aid in the situation.

Physical Examination and Monitoring

  • Palpation Technique:

    • Gently palpate the abdomen, assessing the patient's reaction to identify pain areas.

    • Depending on the level of abruption, fetal heart tones can give insights on baby’s condition.

  • Documentation of Findings: Record any bleeding, contractions, or changes in the fetal heart rate during monitoring.

Laboratory and Imaging Considerations

  • Urine Analysis: Prepares for differential diagnosis and ensures the bladder is emptied.

  • Blood Tests: Perform a full blood count, coagulation profile, and cross-match as per obstetric guidelines during emergencies.

  • Ultrasound: May be required for assessments of placental position and fetal wellbeing.

  • Avoid Digital Vaginal Exams: Prevent exacerbation of bleeding risk; instead, visual inspection is recommended.

Management During Transfer

  • NPO Status: Patients should remain nil by mouth due to the potential for emergency surgical intervention.

  • Oxygen Therapy: Administer oxygen to support both maternal and fetal oxygenation.

  • Intravenous Access: Establish IV lines for fluids and medications as needed during the transfer process.

  • Temperature Management: Maintain warmth to prevent shock during transport.

Post-Arrival Protocol**

  • Continuous Monitoring: Upon arrival, monitor the patient for bleeding or labor signs.

  • Emergency Plan: Discuss potential immediate caesarean sections if indicated due to ongoing bleeding or fetal distress.

  • Fluid Management: Document fluid intake/output while on IV fluids.

Documentation Guidelines

  • Timeliness: Ensure documentation is completed promptly, ideally within 24 hours.

  • Accurate Record-Keeping: Include all details of clinical assessments, results, actions taken, and involved personnel.

  • Informed Consent: Document consent processes and discussions clearly, including all family members and team interactions.

Location of the Placenta

  • Identify the position of the placenta through imaging; normal placement is usually along the upper uterine segment.

Priority of Actions Upon Admission

  • Conduct immediate assessment to evaluate hemodynamic stability.

  • Initiate IV access and monitor vital signs closely.

Additional Measures if Severely Compromised Woman

  • Administer fluids rapidly to stabilize the patient.

  • Prepare for possible surgical intervention if indicated by the clinical scenario.

Possible Outcomes

  • Potential for maternal and fetal compromise requiring close monitoring and intervention.

  • Include possible preterm labor or need for cesarean delivery depending on the severity.

Ongoing Care Where Baby is Not Compromised

  • Monitor maternal vitals and fetal heart rate regularly.

  • Implement supportive care while maintaining stable conditions.

Scope of Practice

  • Clearly define roles and responsibilities of healthcare team members during management and transfer.

Documentation

  • Ensure all actions taken and clinical changes are documented accurately and promptly.

  • Include details of the maternal condition, interventions performed, and communication with the patient and family members.