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Abruption of the

Placenta

Dela Pena, Joyce S

Subgroup No.3 Members:

Alexander, Anneth

Musni, Khreystine Kaye

Group 21

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Abruption of the Placenta

Also termed as:

Abruptio Placentae In premature separation of the placenta, the placenta appears to have been implanted

correctly, however it suddenly begins to separate and bleeding results

Occurs in 10% of pregnancies and is the most frequent cause of perinatal death Occurs late in pregnancy; may occur as late as during the first or second stage of labor

Risk/Predisposing factors:

Unknown High parity Advanced maternal age Short umbilical cord Chronic hypertensive disease PIH Direct trauma Vasoconstriction (from cocaine or cigarette use) Thromophillitic 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% blacks)

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Signs and Symptoms:

The bleeding is characterized by heavy painful, dark red bleeding Sharp, stabbing pain high in the uterine fundus during the initial separation External bleeding if the placenta separates at the edges first and the blood escapes

freely from the cervix

If the placenta separates first at the center, blood may pool under placenta and becomehidden

Blood may infiltrate uterine musculature(which is called Couvelaire uterus orUteroplacental apoplexy) which may form a hard, board-like uterus with no apparent or

minimallyapparent bleeding present

Uterine becomes tense and rigid to touch If the bleeding is extensive, a womans reserve of blood fibrinogen may be sed up in her

bodys attempt to accomplish effective clot formation and DIC(disseminated

intravascular coagulation) syndrome may occur

Shock may occur

Degrees ofSeparation

1-Minimal Separation

-Not enough to cause vaginal bleeding and changes in maternal vital signs

-No fetal distress or hemorrhagic shock occurs

2-Moderate separation

-Evidence of fetal distress

-Uterus is tense and painful on palpation

3-Extreme separation

-Without immediate interventions

-Maternal shock and fetal death

Therapeutic Management

Keep woman in lateral position (not supine) luid replacement through intravenous therapy using large gauge needle Oxygen inhalation through mask Monitor fetal heart sounds Record maternal vital signs every 5-15 minutes Do not perform any vaginal or pelvic examination

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Do not give enema IV administration of fibrinogen or cryoprecipitate (contains fibrinogen) to be used If vaginal birth is not applicable and seems imminent, Cesarean birth is method of

choice(unless DIC has occurred, since it might place a possibility of hemorrhage during

or after the surgery from the surgical incision)

Source:

o Pilliteri, Adele (2010) Maternal & Child Nursing: Care of the Childbearing & theChildbearing Family

Edition 6, Volume 1