HIGH RISK MATERNAL-NEWBORN CARE –
PLACENTA ABRUPTION
CONCEPT: Reproduction NUR 113
Bao-Tse (“Lynn”) is a 34 year old native of Taiwan, married to Tom, a 41 year old
Caucasian. The couple met in Japan where Tom was stationed and Lynn was a
university student. Lynn is a gr ii/p I and has had early and regular prenatal visits. The
couple has 2 children: Susan, age 3 and Tommy, age 9 (Tom’s son from a previous
marriage). Lynn’s family resides in Taiwan so she sees them only infrequently; Tom’s
family members live on the East Coast. Tom is a career military man and Lynn, who
speaks fluent English as well as 3 other languages, works part-time as a translator for a
travel company. They currently live in Portland, Oregon.
Lynn’s second pregnancy progressed normally up to 28 weeks. One day at work she felt
a sudden sharp RUQ pain, which resulted in her losing consciousness. An ambulance
was called. On arrival at the hospital her VS were:
 P120 (Pulse was rapid and thread)
 R 60
 BP 70/0.
Lynn was pale and diaphoretic. On exam a hard area was located in the RUQ of the
abdomen but the entire uterus was board-like. Fetal heart tones (FHT’s) were 90 and
barely audible per Doppler.
A diagnosis of placenta abruption was made, and Lynn’s membranes were ruptured
immediately. She was prepped for a stat C-section. An IV was started with lactated
Ringer’s, a type and cross-match sent for immediate transfusion; oxygen mask and
Foley catheter were in place; internal and external monitors were attached. No
contracting activity was noted, and the fetal tracing was a flat line. A diagnostic survey
of major blood coagulation tests was done.
By this time Tom had arrived at the hospital. He was very overwhelmed by the
confusion and was unable to get anyone to explain the circumstances of the emergency
surgery. He was merely given the consent form to read and sign with a hurried
description of the procedure and risks. Tom was permitted to see Lynn on the
stretscher as they wheeled her down the hallway to the C-section room. The baby was
dead on delivery. All resuscitation efforts failed.
Upon examination of the uterine wall, massive hemorrhage and tearing had occurred.
As vital signs were deteriorating and massive hemorrhaging could not be controlled…an
emergency hysterectomy was performed. Lab results showed: decreased Hct, bleeding
and clotting time; prolonged Pro-time. Vital signs remained unstable through the night
and several units of blood had to be administered. Lynn lapsed in and out of
consciousness.
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com
By morning, Lynn’s condition had stabilized, and she was conscious. Tom had remained
at her bedside all night, and, unfortunately, was the first person available to answer her
questions. Lynn immediately wanted to know why she hurt so badly. “Where’s the
baby?” In a state of hysteria and crying, she received the truth about her son from
Tom.
From that point on, Lynn was labeled a “difficult patient”. She was rude and demanding
to the staff, and seldom satisfied with her care. Lynn refused all visitors, including Tom.
The staff was quite angry because she made frequent visits to the nursery demanding to
have her baby, because her milk was leaking. She was observed spending hours putting
on her makeup and changing her nightgowns. Due to Tom’s frustration and the staff’s
hostility, a social service consult was arranged.
After reading the case study –

Identify all issues you have associated with this situation

Are there potential biases or stigmas involved in this situation? If so, what are
they?

What is your priority of care at various stages during this case? Please provide
rationale for your decisions.

What else could you do for Lynn at this point?

What else could you do for Lynn’s family at this point?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at cathorn1123@aol.com