A patient presents to labor and birth with complaints of persistent acute back pain at 36 weeks' gestation. The nursing assessment reveals a taught abdomen, fundal height at 40 cm, and late decelerations, with an FHR range of 124 to 128 bpm
The nurse will implement the protocol for which obstetric condition?
a. Placenta previa
b. Hypovolemic shock
c. Abruptio placentae or abruption
d. DIC
ANS: C
There are five classic signs and symptoms of abruptio placentae and include the following: bleeding, which may be evident vaginally or be concealed behind the placenta; uterine tenderness, which may be localized at the site of the abruption; uterine irritability, with frequent low-intensity contractions and poor relaxation between contractions; abdominal or low back pain that may be described as aching or dull; and high uterine resting tone identified with the use of an intrauterine pressure catheter. Additional signs include nonreassuring FHR patterns, signs of hypovolemic shock, and fetal death. With a placenta previa there is bright red and painless bleeding. Hypovolemic shock can result from an abruption; however, if the protocol for shock is initiated, some of the blood work that can confirm an abruption will be omitted (e.g., a Kleihauer-Betke test). DIC can result from an abruption. First, look for the cause.
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