placentral abruption

SmilingBluEyes · Dec 19, 2005

I have never handled a FULL abruption---yet.

I had one who was nearly fully abrupted and she had an EPIDURAL so NO PAIN---BUT her baby went "south" and so did mom. Her vital signs started to change---baby tanked. In OR in no time flat, baby out. Initial apgar poor, but recovered well to a 9 at 5 min. We were lucky; dr was here fast, did not wait around for his assistant, just him and the tech, crash, dash, baby out and did ok. Mom did, too. Like I said, lucky. We did dodge a bullet.

SmilingBluEyes · Dec 19, 2005

The scary thing about the above case that got to me:

no pain in mom

no excessive bleeding (it was occult ---- hidden in a "pocket" between placenta and uterus. She DID bleed a lot after delivery. But she did fine.

Dayray, RN · Dec 20, 2005

Sudden and complete abruptions happen but I've never seen one happen while the patient was on the monitor. I've had them come in reporting a sudden sharp pain followed by heavy bleeding and no fetal movement. It's happened for me twice so far and both times I couldn’t find tones by the time they got in.

I did have an experience with a nearly complete abruption. I consider it the highlight of my career and am completely amazed at how my coworkers I handled it.

The patient was a primip. She called her doctor reporting 1 sharp cramp followed by heavy bleeding. The frikin doctor called her in as a R/O SROM and didn’t tell anyone about the cramp or bleeding. It was change of shift and I had just come in. I walked in the room and saw a very pale patient with blood on her hand and chin. She said, "I feel dizzy". I made her get into bed as I reached for the monitor and sort of unconsciously started explaining that blood can be a sign of cervical change or a sign of the baby being in trouble. It's funny now as I look back; I was somehow able to gather a full history and description of what had happened from the patient. It's funny because when I looked at the records I could have only been in the room for a minute or less.

I put the monitor on and got tones in the 30's I slipped the pulseox on and mom’s heart rate was 80. Right at that point Dad snapped a picture and said, "I can't believe its time!". I pulled the call light out of the wall and said "we are going to the operating room, you are going to have a C-section". The patient said "Okay" and the dad said "wha?" I pushed the bed out of the room where another nurse met us and then things moved so quickly and smoothly it seems like it was a dream. As we were running past the nurses station I saw my charge making all the phone calls and other people ran ahead to set the OR.

We got her to the OR, I popped in a 16 gauge and 20 seconds later she was asleep. There were 3 nurses and an MDA in the room everyone moved so fast but perfectly. We couldn’t find tones at all after she was asleep and the OB (who had been pulled out of the hall) cut strait threw the uterus in 1 stroke 110 seconds after the patient had entered the OR. I didn’t look as the baby came out but I was told that it was white as a sheet and floppy. I did see the huge gush of blood as the OB had cut strait into the uterus. It took what seemed to be a long time but to my surprise I heard a cry. APGARs 7 and 9.

The MDA woke up the patient and as she started to come around I said "wake up, your baby is here and she is beautiful" the patient smiled and at that point I came back to myself and realized what had just happened.

Officially the time from when I first put on the monitor to when the baby came out was 6 min but I think it was a little less then that. Later I looked at the strip from the room it had 24 seconds of tones in the 30's.

I had always wondered how I would handle a situation like this and I was kind of scared for the day it would come. Now I'm glad it did come. In those moments I didn’t think about fear or question myself. I just thought about what my next step was and did it. The people I work with did the same and we got a great outcome.

It amazes me how well things went and I'm at a loss to express the feelings I have over it. I guess I feel grateful and honored. We get to do and be part of things that are so amazing and important. As I write this, there is a baby out there somewhere who almost died before she was born. She will grow up, live love, learn and everything else we as humans do. We are truly blessed as nurses to have part in such things.

Also I'd really like to see the look on my face when the dad snaped that picture ..Lol

midwife2b · Dec 20, 2005

WOW!!!!!!!!!!

Dayray, you are a HERO!!!!!!!!!!!!!!:balloons: :balloons: :balloons:

tiamai · Dec 20, 2005

As I said, I have heard of plenty of patial abruptions, but no full abruptions. I experienced a full abruption in April, after being admitted with pre ecclampsia. I had pain all day and lack of foetal movement, but put it down to the fact that my uterus was solid, so I couldnt feel anything. Went to the loo at 5.10pm as I had felt wetness, thought Id leaked urine as my pelvic floor was pretty weak. There was a gush of blood and I pulled the emergency cord. Adrenilin took over so I dont rember much about what happened. The look on the nurses face when she came into the toliet and I said 'Im bleeding' which was pretty obvious with blood all over the floor. Another nurse pinning me to the bed, lying flat, shaking me to stay awake when I closed my eyes, yelling at folk to get out of the way as I was rushed down the hall to labour ward, trying to find babys heart beat, looking at the scanner monitor and seeing his heart beating. Then it dawning on me that I had to have a C section, which I am terrified of. I hate surgery of any kind, one of the reasons I dopped out.

Luckly everyone acted so fast, baby was born at 18.47 after a race to get a theatre ready (there were 3 emergencys at the time, I was the one who dying though, so I won). Interested in seeing it from the profesionals point of view though. thanks.

Dayray, RN · Dec 20, 2005

As I said, I have heard of plenty of patial abruptions, but no full abruptions. I experienced a full abruption in April, after being admitted with pre ecclampsia. I had pain all day and lack of foetal movement, but put it down to the fact that my uterus was solid, so I couldnt feel anything. Went to the loo at 5.10pm as I had felt wetness, thought Id leaked urine as my pelvic floor was pretty weak. There was a gush of blood and I pulled the emergency cord. Adrenilin took over so I dont rember much about what happened. The look on the nurses face when she came into the toliet and I said 'Im bleeding' which was pretty obvious with blood all over the floor. Another nurse pinning me to the bed, lying flat, shaking me to stay awake when I closed my eyes, yelling at folk to get out of the way as I was rushed down the hall to labour ward, trying to find babys heart beat, looking at the scanner monitor and seeing his heart beating. Then it dawning on me that I had to have a C section, which I am terrified of. I hate surgery of any kind, one of the reasons I dopped out.
Luckly everyone acted so fast, baby was born at 18.47 after a race to get a theatre ready (there were 3 emergencys at the time, I was the one who dying though, so I won). Interested in seeing it from the profesionals point of view though. thanks.

Okay, from the way you had worded your original question I thought you ment a suddon and complete abruption. They do happen and are offten the reason for demises. However based on your more complete description, Yes I have seen several situations like the one you describ. The one I highlighted above was the most dramatic.

When this happens you run to the OR fast.

BabyRN2Be · Dec 20, 2005

Okay, from the way you had worded your original question I thought you ment a suddon and complete abruption. They do happen and are offten the reason for demises. However based on your more complete description, Yes I have seen several situations like the one you describ. The one I highlighted above was the most dramatic.
When this happens you run to the OR fast.

Wow, Dayray, what an excellent job!!!

Unfortunately, I have seen full abruption as the reason for several fetal demises.

RNnL&D · Dec 21, 2005

Have seen a few partial abruptions, two in one weekend unbelievably. I remember one Mom reported one sharp pain, then had bright red bleeding for THREE HOURS before coming to the hospital. She wasn't having pain so wasn't sure what to do. She was 18 minutes from door to OR and in that short time the strip went from avg variability to decreased to repetitive lates. That baby was going down. Apgars were 3, 5, and 8. Luckily, she did great after delivery. I still shudder to imagine this Mom waiting to call the office in the morning since she wasn't having pain. :uhoh21:

The only full abruption we've seen, was 12 minutes from triage to delivery. There were just agonal heart tones in triage. Baby didn't make it. Mom had several transfusions, a few in the OR, but made it through.

SmilingBluEyes · Dec 21, 2005

I have seen the results of complete abruption, but none occured on my watch, thank God. And yes, baby was dead in each case, and mom not too peachy herself. It is VERY scary.

judyblueeyes · Dec 22, 2005

I had a case a few years ago with an antepartum pt. I went in to put her on for her scheduled EFM and when she turned a little for the placing of the belts, she leaked alot of blood very quickly. I attempted to locate fht's while calling for assistance but couldn't find any tones. We tranported her to the OR while another nurse manned the phones to the Doc and L&D. A doc was waiting in the OR when we arrived and she had a fast CS but delivered a demise (see below). I suspect she abrupted some time before I came in for the EFM, but didn't notice anything or bleed until she moved. She had a room full of visitors, too.

I don't know the times, but it was very short. We only do OB and deliver well over 600 a month, so our OR's are staffed all the time and everything is always ready to go. This pregnancy was only in the very early 20 week range- maybe 20 or 21, so the outcome would have been the same. Still, it was traumatic for eveyone.

gr8rnpjt, RN · Dec 22, 2005

Sudden and complete abruptions happen but I've never seen one happen while the patient was on the monitor. I've had them come in reporting a sudden sharp pain followed by heavy bleeding and no fetal movement. It's happened for me twice so far and both times I couldn't find tones by the time they got in.
I did have an experience with a nearly complete abruption. I consider it the highlight of my career and am completely amazed at how my coworkers I handled it.
The patient was a primip. She called her doctor reporting 1 sharp cramp followed by heavy bleeding. The frikin doctor called her in as a R/O SROM and didn't tell anyone about the cramp or bleeding. It was change of shift and I had just come in. I walked in the room and saw a very pale patient with blood on her hand and chin. She said, "I feel dizzy". I made her get into bed as I reached for the monitor and sort of unconsciously started explaining that blood can be a sign of cervical change or a sign of the baby being in trouble. It's funny now as I look back; I was somehow able to gather a full history and description of what had happened from the patient. It's funny because when I looked at the records I could have only been in the room for a minute or less.
I put the monitor on and got tones in the 30's I slipped the pulseox on and mom's heart rate was 80. Right at that point Dad snapped a picture and said, "I can't believe its time!". I pulled the call light out of the wall and said "we are going to the operating room, you are going to have a C-section". The patient said "Okay" and the dad said "wha?" I pushed the bed out of the room where another nurse met us and then things moved so quickly and smoothly it seems like it was a dream. As we were running past the nurses station I saw my charge making all the phone calls and other people ran ahead to set the OR.
We got her to the OR, I popped in a 16 gauge and 20 seconds later she was asleep. There were 3 nurses and an MDA in the room everyone moved so fast but perfectly. We couldn't find tones at all after she was asleep and the OB (who had been pulled out of the hall) cut strait threw the uterus in 1 stroke 110 seconds after the patient had entered the OR. I didn't look as the baby came out but I was told that it was white as a sheet and floppy. I did see the huge gush of blood as the OB had cut strait into the uterus. It took what seemed to be a long time but to my surprise I heard a cry. APGARs 7 and 9.
The MDA woke up the patient and as she started to come around I said "wake up, your baby is here and she is beautiful" the patient smiled and at that point I came back to myself and realized what had just happened.
Officially the time from when I first put on the monitor to when the baby came out was 6 min but I think it was a little less then that. Later I looked at the strip from the room it had 24 seconds of tones in the 30's.
I had always wondered how I would handle a situation like this and I was kind of scared for the day it would come. Now I'm glad it did come. In those moments I didn't think about fear or question myself. I just thought about what my next step was and did it. The people I work with did the same and we got a great outcome.
It amazes me how well things went and I'm at a loss to express the feelings I have over it. I guess I feel grateful and honored. We get to do and be part of things that are so amazing and important. As I write this, there is a baby out there somewhere who almost died before she was born. She will grow up, live love, learn and everything else we as humans do. We are truly blessed as nurses to have part in such things.
Also I'd really like to see the look on my face when the dad snaped that picture ..Lol

:yelclap: BRAVO!!!:yelclap: