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    Placenta Abruptio

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    Archana Maharjan
    Abruptio placenta is premature separation of the placenta after 28 weeks of gestation that can cause vaginal bleeding. It is classified as revealed, concealed, or mixed depending on where the bleeding occurs. Risk factors include hypertension, trauma, and cocaine use. Diagnosis is based on vaginal bleeding and abdominal pain after 28 weeks with ultrasound identifying placental separation. Management involves monitoring for hemorrhage and shock, delivering the baby if premature or in distress, and blood transfusion as needed. Complications for mother include hemorrhage, coagulopathy, and renal failure while risks for baby are prematurity and anoxia.

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    Placenta Abruptio

    Uploaded by

    Archana Maharjan
    106 views30 pages
    Abruptio placenta is premature separation of the placenta after 28 weeks of gestation that can cause vaginal bleeding. It is classified as revealed, concealed, or mixed depending on where the bleeding occurs. Risk factors include hypertension, trauma, and cocaine use. Diagnosis is based on vaginal bleeding and abdominal pain after 28 weeks with ultrasound identifying placental separation. Management involves monitoring for hemorrhage and shock, delivering the baby if premature or in distress, and blood transfusion as needed. Complications for mother include hemorrhage, coagulopathy, and renal failure while risks for baby are prematurity and anoxia.

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    Abruptio placenta is premature separation of the placenta after 28 weeks of gestation that can cause vaginal bleeding. It is classified as revealed, concealed, or mixed depending on where the bleeding occurs. Risk factors include hypertension, trauma, and cocaine use. Diagnosis is based on vaginal bleeding and abdominal pain after 28 weeks with ultrasound identifying placental separation. Management involves monitoring for hemorrhage and shock, delivering the baby if premature or in distress, and blood transfusion as needed. Complications for mother include hemorrhage, coagulopathy, and renal failure while risks for baby are prematurity and anoxia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    106 views30 pages

    Placenta Abruptio

    Uploaded by

    Archana Maharjan
    Abruptio placenta is premature separation of the placenta after 28 weeks of gestation that can cause vaginal bleeding. It is classified as revealed, concealed, or mixed depending on where the bleeding occurs. Risk factors include hypertension, trauma, and cocaine use. Diagnosis is based on vaginal bleeding and abdominal pain after 28 weeks with ultrasound identifying placental separation. Management involves monitoring for hemorrhage and shock, delivering the baby if premature or in distress, and blood transfusion as needed. Complications for mother include hemorrhage, coagulopathy, and renal failure while risks for baby are prematurity and anoxia.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 30

    Abruption placenta

    Binu thapa
    Definition
    • Abruptio placenta is one form of ante partum
    hemorrhage where the bleeding occurs due to
    premature separation (after 28 weeks) of
    normally situated placenta

    • It is also called as accidental hemorrhage or


    placental abraption.
    Types
    • Revealed (external) hemorrhage:
     The separation is along the placental margin.
    and blood insinuates downward between the
    membrane and decidua.
     Ultimately the blood comes out of the
    cervical canal to be visible externally. it is
    commonest type.
    Concealed hemorrhage
     The placenta separation centrally and a large
    amount of blood is collect behind the separated
    placenta or collected between the Membranes
    and decidua.
     The collected blood is prevented from coming
    out of the cervix by the presenting part. It is
    rare type.
    Mixed hemorrhage

    • In this type, some part of blood collects


    inside(concealed) and a part expelled
    (revealed).
    • Usually one variety predominates over the
    other. This is quite common.
    Causes
    • Hypertension during pregnancy
    • Placenta abruptio in prevoius pregnancy
    • Trauma due to attempted external cepahilc
    version specially under anesthesia,
    amniocentesis, accident
    • Sudden uterine decompression
    • Short cord
    cont…
    • Previous cesarean section
    • Supine hypotension syndrome
    passive engorgement of the uterine and
    placental vessels resulting in rupture and
    extravasations of the blood.
    • Placental anomaly- cicumvallate placenta
    • Folic acid deficiency
    • Uterine factor
    • Cocaine abuse
    Clinical classification
    • Depending upon the degree of placental
    abruption and its clinical effects, the cases are
    graded as follows:
    • Grade 0
    • clinical features may be absent. The diagnosis
    is made after inspection of placenta following
    delivery.
    Cont…
    • Grade 1- (40%)- (mild separation of placenta)
    1. Vaginal bleeding is slight
    2. Uterus irritable, tenderness may be
    minimal or absent
    3. Maternal BP and fibrinogen levels
    unaffected
    4. FHS good
    Cont….
    • Grade 2- (45%)(moderate separation)
    1. Vaginal bleeding mild to moderate
    2. Uterine tenderness is always present
    3. Maternal pulse is increased, BP maintained
    4. Fibrinogen level may be decreased
    5. Shock is absent
    6. Fetal distress or even fetal death may occur
    Cont….
    • Grade 3 – (15%)(severe separation)
    1. Bleeding is moderate to severe or may be
    concealed
    2. Uterine tenderness is marked
    3. Shock is pronounced
    4. Fetal death is occurs.
    5. Associated coagulation defect or anuria
    may complicate
    Clinical features
    Sign / Revealed type Concealed type
    Symptoms
    Vaginal Usually slight, Absent, but present in
    bleeding continuous dark red, mixed type
    rarely severe bleeding
    Abdominal No severe pain but Acute intense pain
    pain discomfort abdomen. The pain
    becomes continues
    Presenting Edema, headache, This may be present
    symptoms of vomiting rare
    PIH
    Shock Usually Absent present
    Anaemia Related with the Always present
    visible blood loss

    Uterus feel Normal feel with Uterus is tense,


    loacalized tender, hard with
    tenderness rising fundal height
    Fetal parts Can be palpable Fetal part not easily
    easily palpable

    FHS Usually present Fetal heart sound


    not easily audible

    Vulval inspection Slight to heavy Bleeding is absent


    bleeding

    Urine ouput normal Usually diminished


    sonography Differentiate Assess
    placenta previa retroplacental clot

    investigation Hb % low, Hb % markedly low,


    proteinuria absent protein usually
    present
    Diagnosis
    • Symptoms and signs usually present
    1. Bleeding after 28 weeks gestation (may be
    retained in the uterus)
    2. Intermittent or constant abdominal pain
    • Symptoms and sign sometimes present
    1. Shock
    2. Tense/ tender uterus
    3. Decreased/ absent fetal movements
    4. Fetal distress or absent fetal movements

    • Songraphy
    1. Differentiate placenta previa
    2. Assess retroplacental clot
    Prevention
    • Early recognition and effective therapy of
    preeclampsia
    • Avoid cigarette and cocaine
    • Routine administration of folic acid in early
    pregnancy
    • Avoid trauma
    • Avoid sudden decompression of the uterus
    • Avoid supine hypotension syndrome keeping
    patient in left lateral position.
    Management
    • Assessment
    1. Amount of blood loss
    2. Maturity of the fetus
    3. Whether the patient is in labour or not
    4. Presence of any complication
    5. Type and grade of placental abruption
    General management
    • Hb, haematocrit, coagulation profile, ABO, Rh
    sent
    • Urine sent for protein
    • R/L started with bore cannula and make
    arrangement for blood transfusion
    Cont….
    • If mild abruption, vaginal bleeding is light and
    fetus is not in distress, observe the patient in
    hospital and close monitoring

    • If woman’s blood group is Rh negative and


    have placenta abruption gives RhoGam

    • Give oxygen as needed.


    Definitive management
    • Immediate delivery
    – If the patient is in labour-
    If cervix is fully dilated, delivery by vacuum
    extraction
    If vaginal delivery is not possible,
    immediate deliver by caesarean section.
    – If FHR is abnormal –C/S
    Nursing management
    1. Continuous evaluation maternal and fetal
    physiologic status-
    • Vital signs every 1-2 hrs
    • Observe blood loss, amount consistency and
    colour
    • Check for shock (pallor, sweatiness, cold clammy
    skin)
    • Monitor urine output
    • Continue FHS monitoring
    Cont….
    2. Fluid replacement large bore with R/L.
    3. Administer Oxygen
    4. Assess fundal height for changes, if increase
    in size would indicate bleeding.
    5. Be alert for signs of DIC.
    6. Blood transfusion as needed.
    7. Assess the need for immediate delivery if
    women is in active labour, if complicated
    arrange for C/S.
    Complications
    • Maternal
     Hemorrhage
     Shock
     Renal failure
     Blood coagulation disorder, coagulopathy
     PPH
     Puerperal sepsis
    Cont….
    • Fetal
     Prematurity
     Anoxia
     Fetal death
    summary

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