Abruptio Placentae with

Preterm Labor and Delivery

UNFOLDING Reasoning

Michelle Moore, 38 years old

Primary Concept

Perfusion

Interrelated Concepts (In order of emphasis)

1. Reproduction

2. Oxygenation

3. Pain

4. Clinical Judgment

5. Patient Education

6. Communication

7. Collaboration

© 2019 Keith Rischer/www.KeithRN.com

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UNFOLDING Reasoning Case Study: ANSWER KEY

Abruptio Placentae with Preterm Labor and Delivery

History of Present Problem:

Michelle Moore is a 38-year-old who is 29 weeks pregnant. She began prenatal care at 18 weeks gestation because she

was waiting to become insured. She is currently in the Labor and Delivery Unit of the hospital following a call to her

primary care provider. She reported that she had a sudden onset of constant severe uterine pain and began to notice that

she had vaginal bleeding that bright red, soaked a maxi pad and then began soaking through her underwear. Her baby has

not been moving as actively as normal since the pain and bleeding started.

Personal/Social History:

Michelle works at a fast-food restaurant, standing on her feet for long hours. She usually works in the evenings and

weekends. She is estranged from the father of the baby. Michelle’s father is able to help her with childcare once or

twice a week. Michelle denies substance use including alcohol during her pregnancy. Michelle smokes 10 cigarettes

daily, and says that she has decreased usage, but the stress of the pregnancy and having little support makes it difficult

for her to quit.

Michelle reports that she usually eats at work to save money, and most meals consist of fried foods and diet sodas.

Michelle has a small apartment, but says she often has difficulty paying the rent on time, since child care is so expensive.

She has a six-year old son who was born prematurely at 35 weeks. Michelle was diagnosed with a partial abruption

during that delivery.

Past Medical History (PMH): Home Meds: Pharm.

Classification:

Expected Outcome:

 Gravida 4, Para 1 with a partial

abruption at 35 weeks

 Two spontaneous abortions in the first

trimester

 Menses began at age 12, are usually

29 days apart, lasting for 4-5 days,

with moderate-to-light flow.

 Successfully breast fed her first child

for 11 months.

 Vaccinations are up to date.

 Michelle is biracial: African

American and Asian, and she was

tested for sickle cell trait. Lab results

reveal Michelle is a carrier of the

trait. It is unknown if the father of the

baby is also a carrier.

1.Prenatal vitamin 1

tab PO daily

2.Acetaminophen 650

mg PO PRN every 6

hours for infrequent,

mild headaches

1. Multivitamin

2. Analgesic

1. Pt will maintain

adequate iron and

vitamin levels during

pregnancy

2. Pt will be free of mild

headaches

What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?

RELEVANT Data from Present Problem: Clinical Significance:

 38 yrs old

 29 weeks pregnant

 Present at PCP direction

 Severe uterine pain

 Bright red vaginal bleeding

 Reduced fetal movement since onset of

bleeding and pain

 Maturity of handling situation

 If situation escalates to delivery, will need to take required steps

and mobilize appropriate personnel

 Adds immediate validity to situation – facilitates communication

 Uterine pain with bright red blood is an indication of possible

placental abruption

 Reduction of fetal movement is indication of possible fetal distress

RELEVANT Data from Social History: Clinical Significance:

 Works long and night/weekend hours

 Baby’s father not involved; her father

has limited time to help

 Smokes

 Stress of work combined with poor nutrition, and smoking can

negatively impact fetal development

 Support network is insufficient

 Inability to meet financial needs can add psychosocial stress

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