Principle clinical feature of Abruptio placenta?

Central Institute of Psychiatry - 9 July 2022

Obstetrics & Gynaecology

Easy

Appeared in: Central Institute of Psychiatry - 9 July 2022

Explanation

The principal clinical feature of abruptio placentae is the combination of vaginal bleeding with abdominal or back pain.
This condition involves the premature separation of the placenta from the uterine wall, leading to bleeding into the decidua basalis.
The accumulating blood forms a retroplacental hematoma, which irritates the myometrium, causing pain, tenderness, and uterine hypertonicity (rigidity).
The presence of pain is the classic sign that distinguishes placental abruption from placenta previa.

Option A: A rigid or 'board-like' abdomen is a significant sign of a severe placental abruption, resulting from uterine hypertonus and blood extravasating into the myometrium. However, the combination of pain and bleeding is considered the most characteristic or principal feature.
Option B: Painless vaginal bleeding is the hallmark clinical feature of placenta previa, not abruptio placentae. In placenta previa, the bleeding occurs as the lower uterine segment thins and the cervix dilates, tearing the placental attachments without causing significant pain.
Option C: Lengthening of the umbilical cord is a sign of placental separation that occurs during the third stage of labor, after the baby has been delivered. It is not a sign of antepartum placental abruption.

Clinical Relevance

Nursing practice connection: Knowing The primary clinical manifestation of Abruptio Placentae helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Abruptio placentae is an obstetric emergency that can lead to severe maternal hemorrhage, hypovolemic shock, consumptive coagulopathy (DIC), and fetal death.
Immediate nursing actions include establishing two large-bore IV lines for fluid and blood product resuscitation, continuous fetal monitoring, frequent maternal vital sign assessment, and preparing for an emergency cesarean delivery.
A digital vaginal exam is contraindicated until placenta previa is ruled out by ultrasound, as it can provoke catastrophic hemorrhage.

How to Approach the Question

First, identify the keyword in the question: 'Abruptio placenta'.
Recall the definition of abruptio placentae: the premature separation of the placenta from the uterine wall.
Think about the pathophysiology: separation causes bleeding, and the blood irritates the uterus. This leads to the classic triad of symptoms: vaginal bleeding, abdominal pain/uterine tenderness, and uterine hypertonicity.
Evaluate the options based on this knowledge. 'Painful vaginal bleeding' directly combines the two most prominent symptoms.
Differentiate from the main alternative diagnosis, placenta previa, which is characterized by 'painless' bleeding. This contrast helps confirm the correct answer.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 63-85