Abruptio Placentae

Placental abruption (Also known as abruptio placentae) is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies world wide with a fetal mortality rate of 20-40% depending on the degree of separation. Placental abruption is also a significant contributor to maternal mortality.
Common risk factors for placenta abruptio include:
* High blood pressure (140/90 mm Hg or higher), whether it is chronic or has been caused by the pregnancy (pregnancy-induced hypertension or preeclampsia). High blood pressure is the most common risk factor linked to placenta abruptio.4
* A past placental abruption. If you have had more than one abruption, your risk is greater.2
* Cigarette smoking. The more you smoke, the greater your risk of abruption. Up to 25 of every 100 placental abruptions are linked to cigarette smoking.5
Other risk factors for placenta abruptio include cocaine use; having a surgical scar or uterine fibroid where the placenta has attached; trauma to the uterus, as might occur in a car accident;
Abruptions are classified according to severity in the following manner:
Grade 0: Asymptomatic and only diagnosed through post partum examination of the placenta.
Grade 1: The mother may have vaginal bleeding with mild uterine tenderness or tetany, but there is no distress of mother or fetus.
Grade 2: The mother is symptomatic but not in shock. There is some evidence of fetal distress can be found with fetal heart rate monitoring.
Grade 3: Severe bleeding (which may be occult) leads to maternal shock and fetal death. There may be maternal disseminated intravascular coagulation. Blood may force its way through the uterine wall into the serosa, a condition known as Couvelaire uterus.
Signs/Symptoms
* contractions that don’t stop
* pain in the uterus
* tenderness in the abdomen
* vaginal bleeding (sometimes)
* bach ache
Exams and Tests
Tests may include:
* Pelvic exam
* CBC, may note decreased hematocrit or hemoglobin and platelets
* Prothrombin time test
* Partial thromboplastin time test
* Fibrinogen level test
* Abdominal ultrasound
Lasting effects
On the mother:
* A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
* The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract. ‘APH weakens, for PPH to kill’.
* 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), the doctor may consider a hysterectomy.
* A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland.
* 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. It may die inutero, 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.
Treatments for the condition
This condition is usually an emergency and requires treatment right away. Measures will be taken to keep the mother and baby healthy.

This might include:
* -immediate and continuous monitoring of the unborn child
* -IV fluids
* -monitoring of vital signs, such as blood pressure, heart rate, and urine output
* -“watchful management” if the baby is not in distress, the mother’s vital signs are stable, and labor is not in motion. Some small abruptios will stop bleeding on their own.
* -vaginal delivery if the unborn child and mother are stable
* -cesarean birth if the mother or baby are unstable
* -blood transfusion if signs of shock are present
Nursing Responsibility
* Monitor amount of bleeding by weighing all pads and assess the presence and absence of pain.
* Monitor maternal vital signs and fetal heart rate through continuous external fetal monitoring.
* Monitor uterine contractions.
* Measure and record fundal height, which may increase with concealed bleeding.
* Monitor hemoglobin and hematocrit for blood lost.
Pathophysiology
Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption.
Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death.