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Zorluk: ZorAnte/Intra/Postpartum and Newborn Care

A nurse is evaluating a client at 35 weeks gestation who arrived at the emergency department following a high-speed motor vehicle collision. The client reports mild, continuous abdominal discomfort but denies any visible vaginal bleeding. Which of the following assessment findings should the nurse identify as indicators of a concealed placental abruption and impending hemorrhagic shock? Select all that apply.

  1. Maternal resting heart rate of 118 beats per minuteCevap
  2. A rigid, board-like abdomen upon palpationCevap
  3. Fetal heart rate baseline of 175 beats per minuteCevap
  4. D
    Presence of consistent early decelerations on the fetal tracing
  5. E
    A widening maternal pulse pressure on serial blood pressure readings
  6. F
    Maternal urinary output of 45 mL over the first hour of admission

Cevap

The correct findings are a maternal resting heart rate of 118 beats per minute, a rigid and board-like abdomen, and a fetal heart rate baseline of 175 beats per minute.
Concealed placental abruption occurs when the placenta separates from the uterine wall but the margins remain attached, trapping the bleeding. This concealed hemorrhage increases uterine resting tone, leading to a classic rigid, board-like abdomen. As blood is lost into the uterine cavity, the mother's body compensates for the hypovolemia by increasing her heart rate (tachycardia). Concurrently, the reduced maternal blood volume compromises uteroplacental perfusion, leading to early fetal hypoxia, which typically manifests as fetal tachycardia (a baseline greater than 160 beats per minute).

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1
Analyze the clinical scenario
The client has experienced blunt force abdominal trauma (motor vehicle collision) and is reporting continuous discomfort without visible bleeding, which is highly suspicious for a concealed placental abruption.
Trauma is a major risk factor for placental abruption, and the absence of external vaginal bleeding does not rule out internal (concealed) hemorrhage.
2
Identify direct signs of concealed hemorrhage
A rigid, board-like abdomen occurs because blood trapped behind the placenta infiltrates the myometrium, significantly increasing uterine resting tone.
This is the primary physical manifestation of concealed bleeding within the uterus.
3
Identify early systemic signs of hypovolemic shock in the mother
A maternal heart rate of 118 bpm (tachycardia) is an early compensatory sign. A widening pulse pressure is an incorrect finding (it should narrow), and a urine output of 45 mL/hr is completely normal.
The body compensates for acute blood loss by increasing the heart rate and inducing peripheral vasoconstriction before the systolic blood pressure drops significantly.
4
Identify early signs of fetal hypoxia
A fetal heart rate baseline of 175 bpm (tachycardia) indicates early hypoxia due to compromised uteroplacental perfusion. Early decelerations are benign and unrelated to hypoxia.
The fetus responds to initial hypoxemia with sympathetic nervous system stimulation, causing a sustained elevation in the baseline heart rate.

Anahtar Kavram

Clinical manifestations of concealed placental abruption and early hemorrhagic shock
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Ante/Intra/Postpartum and Newborn Care

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