QLexNursing

Abdominal assessment → Abruptio placentae

🔷 Abruptio placentae typically presents with a tender, board-like abdomen on palpation due to myometrial tetany and concealed or revealed bleeding.

🔷 The uterine surface often feels firm and irritable, reflecting increased uterine tone rather than a relaxed uterus.

🔷 These exam findings arise from placental separation and blood dissecting into the decidua/myometrium, generating notable abdominal rigidity.

🔷 The abdominal exam may also elicit significant maternal discomfort, consistent with painful placental detachment.

🔷 Recognition of this abdominal profile prompts urgent evaluation for maternal hemodynamic status and fetal well-being.

Abdominal pain level → Abruptio placentae

🔷 Abruptio placentae is classically painful, with sudden, constant, or severe abdominal/low-back pain accompanying the event.

🔷 Pain correlates with uterine irritability and tonic contractions, reflecting myometrial involvement by bleeding.

🔷 Clients may describe unremitting pain rather than intermittent cramping, aligning with acute placental separation.

🔷 Pain intensity can be present with or without visible bleeding, particularly when bleeding is concealed.

🔷 Prompt identification of significant pain accelerates resuscitative and obstetric interventions to limit maternal–fetal morbidity.

Hemoglobin level → Both (Placenta previa and Abruptio placentae)

🔷 Both placenta previa and abruptio placentae involve maternal blood loss, so hemoglobin/hematocrit decrease is consistent with either diagnosis.

🔷 In placenta previa, overt bright-red bleeding commonly mirrors the measured drop in hemoglobin.

🔷 In abruption, the hemoglobin decline may be disproportionate to external bleeding because loss can be concealed within the uterus.

🔷 Trending CBC values alongside vitals (e.g., tachycardia, hypotension) helps quantify the degree of hemorrhage.

🔷 Declining hemoglobin in either condition warrants escalation, crossmatch, and hemorrhage bundle preparedness.

Description of vaginal bleeding → Placenta previa

🔷 Placenta previa classically presents with painless, bright-red vaginal bleeding, often after 20 weeks of gestation.

🔷 The bleeding is due to placental implantation over or near the cervical os, which can shear with cervical change.

🔷 The uterus is typically soft and non-tender, distinguishing it from the rigid, painful picture seen with abruption.

🔷 Bleeding can be recurrent and unpredictable, particularly with activity or cervical manipulation.

🔷 Immediate priorities include no digital exams, ultrasound confirmation, and hemorrhage surveillance.

Uterine tone → Abruptio placentae

🔷 Increased uterine tone (a firm, “board-like” uterus) is a hallmark of abruptio placentae.

🔷 The tone elevation reflects intrauterine bleeding with myometrial irritability and sustained contractions.

🔷 Clinically, tone changes may coincide with fetal distress from compromised uteroplacental perfusion.

🔷 This contrasts with conditions where the uterus remains soft/relaxed, which is not typical of abruption.

🔷 Persistent hypertonus directs urgent stabilization, imaging, and delivery planning as indicated.