PREMATURE

SEPARATION OF
THE PLACENTA
Abruptio Placentae

Abruptio
Placenta

Placenta is implanted
correctly
Suddenly separates and
bleeding results
10% of pregnancies
Most frequent cause of
perinatal death
Occurs late in pregnancy

Abruptio
Placenta

Separation occurs late

in pregnancy
First or second stage of
labor

Cause is unknown
Chorioamnionitis
an infection of the fetal
membranes and fluid

Predisposing
factors:

High parity
Advanced maternal age
Short umbilical cord
Chronic hypertensive disease
Pregnancy induced hypertension
Direct trauma (as from an automobile
accident or intimate partner abuse)
Vasoconstriction from cocaine or
cigarette use
Thrombophilitic conditions that lead to
thrombosis such as autoimmune
antibodies, protein C, and factor V Leiden
(a common inherited thrombophilia that
occurs in 5% of whites and 1% of blacks

Assessment

Sharp, stabbing pain

High in the uterine fundus as the
initial separation occurs
Each contraction will be accompanied
by pain over and above the pain of
the contraction
Uterine tenderness
Heavy bleeding
If the center of the placenta
separates first, blood can pool
under the placenta, and although
bleeding is intense, it is hidden
from view
shock usually follow quickly

Assessment

Uterus becomes tense and feels rigid

to the touch
Couvelaire uterus
Or uteroplacental apoplexy, forming
a hard, board like uterus with no
apparent, or minimally apparent,
bleeding present occurs.
If blood infiltrates the uterine
musculature
As bleeding progresses, a womans
reserve of blood fibrinogen may be
used up in her bodys attempt to
accomplish effective clot formation,
and disseminated intravascular

Assessment

Assess the time the

bleeding began, whether
pain accompanied it
The amount and kind of
bleeding
Her actions to detect if
trauma could have led to
the placental separation

Therapeutic
Management

An emergency situation
IV insertion (using large catheter) for fluid
replacement
Oxygen by mask to limit fetal anoxia
Monitor fetal heart sounds
Record maternal vital signs every 5 to 15
minutes to establish baselines and
observe progress
Baseline fibrinogen determination
Keep a woman in a lateral, not supine,
position to prevent pressure on the vena
cava and additional interference with fetal
circulation

Therapeutic
Management

It is important not to disturb

the injured placenta any further
do not perform any abdominal,
vaginal, or pelvic examination on
a woman with a diagnosed or
suspected placental separation
If vaginal birth does not seem
imminent, cesarean birth is the birth
method of choice
DIC has developed, cesarean
surgery may pose a grave risk
because of the possibility of
hemorrhage during the surgery and

Therapeutic
Management

Intravenous administration of
fibrinogen or cryoprecipitate
(which contains fibrinogen) may
be used to elevate a womans
fibrinogen level prior to and
concurrently with surgery
With the worst outcome, a
hysterectomy might be
necessary to prevent
exsanguination

Fetal
prognosis

Depends on the extent

of the placental
separation and the
degree of fetal hypoxia

Maternal
prognosis

Depends on how
promptly treatment
can be instituted

PREMATURE
SEPARATION OF THE
PLACENTA:
DEGREES OF
SEPARATION

Degrees
of
Separation

Premature
Separation
of the
Placenta

Death can occur from massive

hemorrhage leading to shock and
circulatory collapse or renal failure from
the circulatory collapse.
Any woman who has had bleeding
before birth is more prone to infection
after birth than the average woman
A woman with a history of premature
separation of the placenta, therefore,
needs to be observed closely for the
development of infection in the