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20 cases of severe placental abruption Nursing


Key words: severe placental abruption; care Abstract Summary of 20 cases of severe placental abruption care. Strengthen health education and high-risk pregnancy pregnancy management, attention to pregnant women with risk factors of placental abruption; close observation of the disease, attention is not typical symptoms, to detect signs of placental abruption, early diagnosis and early treatment to reduce maternal mortality. The group of 11 patients with 20 cases of uterine placental stroke, postpartum hemorrhage occurred in 9 patients, 5 patients with disseminated intravascular coagulation (DIC), 1 cases with renal failure, was found to deal with in a timely manner, were cured. Chinese papers League finishing. Key words severe placental abruption; care abruption is a serious obstetric complications, is one of the major late pregnancy bleeding, according to the literature [1] reported, the rate was 0.46% ~ 2.1 %, perinatal mortality rate was 25%. Placental abruption, acute onset, rapid development, often complicated with postpartum hemorrhage, coagulation disorders, kidney failure, stillbirth, uterine complications such as stroke and serious threat to maternal life [2]. Our hospital on 1 December 2006 were treated in 20 patients with severe placental abruption, the prognosis is good, now nursing experience reported below. 1 clinical data 1.1 General Information age of 26 to 36 years old, 26 to 40 weeks gestational age, pregnancy <32 weeks in 6 cases. 18 cases of singleton pregnancies, twin 2 cases. Primipara 13 cases, the mother of 7 cases. 2 patients had never prenatal examination, 1 case of stillbirth. 1.2 in 20 patients with clinical manifestations of the apparent abdominal pain, vaginal bleeding as the main manifestation in 5 patients, only abdominal pain, bloating, and no vaginal bleeding as the main manifestation in 3 cases, vaginal bleeding as the main performance only 7 cases . There are other clinical manifestations of fetal distress, bloody amniotic fluid, urine output decreased and so on. 1.3 auxiliary examination done 20 cases of B-ultrasound in 18 cases, indicating that 13 cases of placental abruption. Laboratory decreased fibrinogen, 6 cases of prolonged prothrombin time and thrombocytopenia in 8 patients. 20 patients, 17 patients were 3P test, 5 cases were positive, weakly positive in 1 case. 1.4 19 cases cesarean section maternal and child outcomes, and 1 smooth production. 9 cases of postpartum hemorrhage, uteroplacental apoplexy occurred in 11 cases, combined DIC2 cases of prenatal and postnatal combined DIC3 cases of renal failure in 1 case. Stripping an area of ​​1 / 3 to 2 / 3,> 1 / 2 in 9 cases, no maternal deaths. 8 cases of neonatal asphyxia with mild and severe asphyxia in 3 cases were healthy and discharged after treatment, fetal death in 1 case. 2 nursing 2.1 good prenatal care, regular attention to the high-risk pregnant women, prenatal identification, active monitoring, strengthening the knowledge of perinatal health mission, the women realize the dangers of high-risk pregnancy, which actively cooperate with the health care treatment and care staff is the key to prevention of placental abruption. 2.2 to detect signs of attention to risk factors for placental abruption, hypertensive disorders in pregnancy for the merger, IUGR, diabetes, premature rupture of membranes such as pregnant women should be alert to the occurrence of placental abruption. Abdominal pain, bloating, tension increased in the uterus or vaginal bleeding should be promptly line B-Check. Closely observe the situation of vaginal bleeding at any time to monitor the fundus height, watch for uncoordinated contractions of high tension, to observe changes in fetal heart rate fetal movement and amniotic fluid character, with doctors and timely submission coagulation, DIC, in order to detect placental abruption Early signs of winning time for the rescue. 2.3 psychological care in patients with severe placental most rapid onset, rapid development, great harm to the mother and child, diagnosed with placental abruption, the rescue to be calm calm, good communication with their families, trying to ease the fear of the patient's anxiety. 2.4 severe abruption against the clock to rescue 2.4.1, active treatment once diagnosed or highly suspected placental abruption occurs, every second counts to be active for processing. Immediate oxygen, bedside ECG monitoring, take the left decubitus, shock shock patient was supine, the rapid establishment of two centrifugal near intravenous access, catheter use, timely submission blood and DIC, do cross-matching of blood , prepared for the blood transfusion, to ensure smooth blood transfusion to maintain the effective circulating blood volume and correct shock. 2.4.2 observe the dynamic changes of the disease more severe placental Department of bleeding, need close monitoring of mind, complexion, heart rate, blood pressure, oxygen saturation changes in vital signs; to observe the nature of abdominal pain, uterine end of the height of the uterus tension change; bedside fetal heart sound monitoring, attention to fetal movement changes, to determine the circumstances and maternal intrauterine bleeding condition; accurate record of intake and output, note the amount of vaginal bleeding, nature. Observed in patients with gums, skin, mucous membranes and the injection site with or without bleeding, concerns the clotting time, platelet count and other laboratory reports, to detect early signs of DIC. Operation of all the checks and care should be gentle, to avoid a sudden change position, the action to minimize the increase in abdominal pressure [3], to help doctors make obstetric treatment, once diagnosed, should be prepared immediately before surgery and neonatal well prepared to rescue, rapid termination of pregnancy. 2.5 complications 2.5.1DIC observation and nursing observation and care within 24h after delivery, the patient absolute bed rest, abdominal incision sandbags continued pressure to reduce bleeding. If the placenta after delivery vaginal bleeding, no blood clots, decreased platelets, fibrinogen 15s, prothrombin time> 21s, should be immediately opened a number of intravenous access, lost Note the new blood, blood components, or clotting factors, actively cooperate with the cause of treatment [4]. Blood samples were timely and accurate dynamic monitoring of laboratory results, close observation of the response after treatment, unusual, timely reporting of a doctor. 2.5.2 Observation and nursing of postpartum hemorrhage in case of postpartum hemorrhage, immediately to the oxygen, warmth, rapid establishment of two intravenous access and rapid blood transfusion. Continuous ECG monitoring, close observation of patients with consciousness, blood pressure, pulse, respiration,[link widoczny dla zalogowanych], blood oxygen saturation changes, so too much fluid, too fast and acute pulmonary edema. Oxygen should be closely observed during the effect of oxygen, such as complexion, lip weeks, the nail is turn rosy, smooth breathing is restored. Accurate measurement of blood storage device with vaginal blood loss, and make a record. If it is found uterine contour is unclear, soft uterus, suggesting that uterine inertia, immediately massage the uterus, such as the use of uterotonic oxytocin, misoprostol, etc., if the patients showed thirst, systolic blood pressure 100 times / min, urine output <30ml / h, the skin cold and wet, cyanosis, and rescue medication should be ready to meet the medical rescue. Renal failure 2.5.3 Observation and nursing care accurately measure the amount of 24h access, in particular, urine output per hour, close observation of changes in urine of patients. Dynamic monitoring of renal function, electrolytes, urine specific gravity, urine color. If patients with little or no urine, urine output of less than 17ml / h or 400ml/24h, based on blood volume in the supplementary use of diuretics, urine output does not increase and serum urea nitrogen, creatinine, potassium progressively increased, and carbon dioxide combining power down, suggesting the possibility of acute renal failure. Given to strictly limit the amount of fluid intake to prevent water intoxication. Patients with absolute bed rest, in order to reduce the decomposition of protein, reduced azotemia. Give digestible high-sugar, high-quality low-protein, low potassium, calcium, vitamin-rich diet and avoid eating high potassium foods and drugs, stop using the drug for kidney damage, if necessary, timely and hemodialysis treatment.