ABRUPTIO PLACENTA

"What is abruptio placentae?"

"Premature separation of a normally implanted placenta from the uterine wall before delivery."

"How does abruptio placentae differ from placenta previa?"

"In abruptio placentae the placenta separates early, while in placenta previa it is abnormally implanted in the lower uterus."

"What is the incidence of abruptio placentae?"

"About 10 per 1,000 pregnancies."

"Why is abruptio placentae dangerous?"

"It can cause severe maternal hemorrhage and is a leading cause of perinatal death."

"When does abruptio placentae usually occur?"

"Late in pregnancy or during labor."

"What are risk factors for abruptio placentae?"

"High parity, advanced maternal age, hypertension, trauma, cocaine or smoking use, thrombophilia, short umbilical cord, and infection."

"How can chorioamnionitis lead to abruptio placentae?"

"Infection weakens placental attachment and contributes to separation."

"What is a possible effect of sudden uterine volume decrease?"

"It may trigger placental separation due to rapid change in uterine size."

"What is the initial symptom of abruptio placentae?"

"Sudden sharp, stabbing abdominal or uterine pain."

"How is pain described in abruptio placentae during labor?"

"Pain is greater than expected and accompanies each contraction."

"What is uterine tenderness in abruptio placentae?"

"The uterus is painful on palpation due to irritation and bleeding."

"What type of bleeding occurs in abruptio placentae?"

"Vaginal bleeding that may be visible or concealed."

"What is concealed hemorrhage in abruptio placentae?"

"Bleeding is trapped behind the placenta, making external bleeding minimal or absent."

"What is revealed hemorrhage in abruptio placentae?"

"Blood escapes through cervix and is visible vaginally."

"What is the uterus like in abruptio placentae?"

"Tense, rigid, and boardlike due to blood infiltration."

"What is a Couvelaire uterus?"

"A condition where blood infiltrates uterine muscle, making it hard and noncontractile."

"What serious complication can develop from abruptio placentae?"

"Disseminated intravascular coagulation (DIC)."

"Why does DIC occur in abruptio placentae?"

"Due to consumption of fibrinogen and clotting factors from ongoing bleeding."

"What initial labs are done in abruptio placentae?"

"Hemoglobin, blood typing and crossmatch, fibrinogen level, and fibrin degradation products."

"Why is abruptio placentae an emergency?"

"It threatens maternal circulation and fetal oxygen supply."

"What is the initial management of abruptio placentae?"

"Large-bore IV access, oxygen therapy, and continuous monitoring."

"What position should the patient be placed in?"

"Lateral position to improve circulation and avoid vena cava compression."

"Why should abdominal and vaginal exams be avoided?"

"They may worsen placental separation and bleeding."

"What fetal monitoring is used in abruptio placentae?"

"External fetal heart rate monitoring."

"What vital sign monitoring is required?"

"Frequent monitoring every 5–15 minutes for signs of shock."

"What determines the need for delivery in abruptio placentae?"

"Severity of separation and fetal/maternal condition."

"What is the preferred mode of delivery in severe abruptio placentae?"

"Cesarean birth if vaginal delivery is not imminent."

"When can vaginal birth occur in abruptio placentae?"

"If separation is minimal and labor is progressing rapidly."

"What is grade 0 abruptio placentae?"

"No clinical symptoms; diagnosis made after birth."

"What is grade 1 abruptio placentae?"

"Minimal separation with vaginal bleeding but no fetal distress."

"What is grade 2 abruptio placentae?"

"Moderate separation with fetal distress and tense uterus."

"What is grade 3 abruptio placentae?"

"Severe separation causing maternal shock and fetal death risk."

"What is the fetal risk in abruptio placentae?"

"Hypoxia and possible fetal death."

"What is the maternal risk in abruptio placentae?"

"Hemorrhagic shock, renal failure, or death."

"What blood products may be given in DIC with abruptio placentae?"

"Fibrinogen or cryoprecipitate."

"When is hysterectomy considered in abruptio placentae?"

"In severe cases with uncontrollable hemorrhage."

"What postpartum complication risk is increased after abruptio placentae?"

"Infection."

"Why is infection risk higher postpartum in abruptio placentae?"

"Because of bleeding and tissue damage before delivery."