ABRUPTION PLACENTA

-Theprematureseparation of a normally implanted placenta afterthe20thweek of pregnancy, typically with

severehemorrhage.
Types:
a.Central
b.Marginal
c.Complete

According to extent of separation:

1.Mild:less than 1/6 of placenta is separated bleeding may or may not bepresent (<250 cc),
someuterineirritability withno fetal distress, theremay ormay not bevaginal bleeding,vaguebackache
2.Moderate:1/6-2/3 separation.Dark vaginal bleeding (<1000mL), with fetal distress, uterinetenderness
3.Severe:morethan 2/3 is separated, uterinetenderness,rigidity, dark vaginal bleeding (>1000 mL) however it
maybe absentexternally, fetal distress and fetal death, if separatedentirely- maternal shock and f
etaldeath,severepain, DIC
Etiology:
1.Thecauseis unknown
2.Risk factors may include:
a.Uterineanomalies
b.Multiparity
c.Preeclampsia -Maternal HPN
d.Previous caesarian birth
e.Renal and vasculardisease
f.Trauma to theabdomen
g.Previous third trimester bleeding
h.Abnormally largeplacenta
i. Short umbilical cord
j. Sudden release of AF
3.Behavioral factors:
a. cigarette smoking, methamphetamine, cocaine abuse
b. maternal alcohol consumption (14 or more drinks per week)
Assessment:
1.Sharp, stabbing pain high in theuterinefundus
2. Heavy vaginal bleeding if separation begins at placentaledges
3.Concealed bleeding if thecenteroftheplacenta separates first
4.Uterus firm to board-like, tenseorrigid

5.s/sxof anemia
6.s/sxof hypovolemic shock
Management:
1.hospitalization
2.FHR monitoring
3.Maternal V/Smonitoring, I and O monitoring, abdominal circumferenceand fundic height-sudden increasemay
indicateinternal bleeding,uterinecontractions secondary toreleaseof prostaglandins by placental separation
4.Properpositioning bedrest at side lying position
5.IV Fluid administration LR is usually given at 125 cc perhour
6.Blood typing and cross matching
7.Oxygen administration
8.No pelvic, abdominal orvaginalexamination
9.Administerprescribed medications:bethametasone, tocolytic therapy (terbutaline) (ritodrine),MgSO4) formild
abruption placenta but contraindicated in moderateto severecases forit mayconceal s/s of properdiagnosis
andevaluation.
10.Caesarean birth Is preferred
11.Vaginal delivery is possible if fetus is already dead, thereis minimal bleeding and motheris stable
LASTING EFFECTS:
On the mother:
A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery. 'APH
weakens for PPH to kill'.
The uterus may not contract properly after delivery so the mother may need medication to help her uterus
contract.
The mother may have problems with blood clotting for a few days.
If the mother's blood does not clot (particularly during a caesarean section) and too many transfusions could
put the mother into disseminated intravascular coagulation (DIC) due to increased thromboplastin, the doctor
may consider a hysterectomy.
A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland. Diffuse cortical
necrosis in the kidney is a serious and often fatal complication.
In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme
pain is felt and reported.
On the baby:
If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery
and may die in utero, thus resulting in a stillbirth.
The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have
problems with breathing and feeding.
If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth.
The newborn may have low blood pressure or a low blood count.
If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.
The newborn may have learning issues at later development stages, often requiring professional pedagogical
aid.
Intervention
INTERVENTIONS:
Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with or without
bleeding. The fundus may be monitored because a rising fundus can indicate bleeding. An ultrasound may be
used to rule out placenta praevia but is not diagnostic for abruption. The mother may be given Rhogam if she is
Rh negative.
Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks
and neither mother or fetus is in any distress, then they may simply be monitored in hospital until a change in
condition or fetal maturity whichever comes first.
Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother is in distress.
Blood volume replacement to maintain blood pressure and blood plasma replacement to maintain fibrinogen
levels may be needed. Vaginal birth is usually preferred over caesarean section unless there is fetal distress.
Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Patient should be
monitored for 7 days for PPH. Excessive bleeding from uterus may necessitate hysterectomy.