ABRUPTIO PLACENTA

Definition

• Abruptio placentae (also known as placental

abruption) is the premature separation of
the placenta that occurs late in the pregnancy.
 Pathophysiology

• The placenta has implanted in the correct location.

• For some unknown reasons, it suddenly begins to
separate, causing bleeding.
• This separation would occur late in pregnancy, and
accounts for 10% of perinatal deaths.
 Risk Factors

The following are the risk factors that surround

abruptio placenta and these should be made known to all
pregnant mothers to avoid development of this fatal
condition.
• High parity. A woman who has given birth multiple
times predisposes herself to abruptio placentae.
• Short umbilical cord. A short umbilical cord could cause
the separation of the placenta especially if trauma
 Risk Factors

• Advanced maternal age. Women over the age of 35

years old have higher risk of acquiring abruptio
placentae.
• Direct trauma. Any trauma to the abdomen could cause
a separation of the placenta.
• Chorioamnionitis. This is an infection of the fetal
membranes and fluid that could predispose the woman
to premature placental separation.
 Types

The types of abruptio placenta are measured

according to the degree of placental separation that
has occurred.

• Grade 0. No indication of placental separation and

diagnosis of slight separation is made after birth.
 Types

• Grade 1. There is minimal separation which causes

vaginal bleeding, but no changes in fetal vital signs
occur.
• Grade 2. Moderate separation occurs and fetal distress
is already evident. The uterus is also hard and painful
upon palpation.
• Grade 3. Extreme separation; maternal shock and fetal
death is imminent if no interventions are done.
 Signs and Symptoms

• The signs and symptoms of

abruption placenta must be monitored and
detected early before it progresses to a critical
stage.
• Sharp, stabbing pain. A woman may experience
the pain on the upper uterine fundus as initial
separation occurs.
 Signs and Symptoms

• Heavy bleeding. This usually happens after the

separation of the placenta. External bleeding will
only occur if the placenta separates first from the
edges. Internal bleeding will occur
if placenta separates from the center
because blood would pool under it.
• Uterus is tense and rigid. it appears as a board-
like, hard uterus without any bleeding.
 Diagnostic Tests

• These diagnostic procedures would be enforced

by the physician to finally diagnose the presence
of abruption placenta.
• Hemoglobin level and fibrinogen level. These
tests are performed to rule out disseminated
intravascular coagulation (DIC).
 Medical Management
• To avoid a worsening condition, these medical procedures
are implemented for both the mother and the fetus.
• Intravenous therapy. Once the woman starts to bleed, the
physician would order a large gauge catheter to replace the
fluid losses.
• Oxygen inhalation. Delivered via face mask, this would
prevent fetal anoxia.
• Fibrinogen determination. This test would be taken several
times before birth to detect DIC.
 Surgical Management

• Once the condition has reached a stage that mightily

endangers the life of both patients, then surgical
management is put into action.
• Cesarean delivery. If birth is imminent, it is safest to
deliver the baby via caesarean delivery.
• Hysterectomy. The worst outcome would be for the
woman to develop DIC, hysterectomy must be performed.
 Nursing Management
• A vital role is also upheld by the nurses during this situation.
Their accurate assessment would be one of the baseline data
for all health care providers to plot the care plan for the
patient.
Nursing Assessment
• Assess for signs of shock, especially when
heavy bleeding occurs.
• Assess if the bleeding is external or internal.
 Nursing Management
• Monitor contractions if separation occurs during labor.
• Obtain baseline vital signs.
• Assess for the time the bleeding began, the amount and kind
of bleeding, and interventions done when bleeding occurred
if it started before admission.
• Assess for the quality of pain.
 Nursing Management

• Nursing Interventions
• Place the woman in a lateral, not supine position to avoid
pressure in the vena cava.
• Monitor fetal heart sounds.
• Monitor maternal vital signs to establish baseline data.
• Avoid performing any vaginal or abdominal examinations
to prevent further injury to the placenta.