Abruptio Placenta

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Abruptio Placenta

A complication of late pregnancy or labor characterized by premature (early) partial / complete separation of the placenta from the uterus. Primary Cause is unknown

Occurs mostly around

25 wks of pregnancy

2nd leading cause of

Bleeding the 3rd; occurs in 1:300 pregnancies

Other terms

accidental miscarriage, ablatio placenta

Type I / Classic Type

Concealed, covert, central type. Placenta separates at the center, causing blood to accumulate behind the placenta. External bleeding not evident. Signs of shock are not proportional to the amount of external bleeding.

Type II / External bleeding type

Marginal, overt. Placenta separates at the margins. External bleeding (old, dark red) is usually proportional to the amount of internal bleeding. May be complete / incomplete depending on the degree of placental detachment

Type III / Mixed

Some part of the blood collects inside (concealed), and some parts expelled out (revealed)

Signs and Symptoms

• Early Stages there may be no symptoms

• Sudden onset abdominal pain

• Contractions that seem continuous and won’t stop

• Painful vaginal bleeding 3rd trimester

• Rigid, board-like, and painful abdomen

• Enlarged uterus disproportionate to the AOG

• Decreased fetal movement and heart rate due to lack of nutrients and oxygen

• If in labor: tetanic contractions with the absence of alternating contractions and relaxations of the uterus

Partial separation (concealed hemorrhage)

Partial Separation (Apparent Hemorrhage)

Complete Separation (Concealed Hemorrhage)

Grade 0

No symptoms of separation are apparent from maternal / fetal signs

Diagnosis is made after birth when placenta is examined and a segment of the placenta shows a recent adherent clot on the maternal surface

Grade 1

Minimal separation; not enough to cause vaginal bleeding and changes in maternal vital signs

No fetal distress or hemorrhagic shock occurs

Grade 2

Moderate separation

No evidence of fetal distress

Uterus is tense and painful on palpation

Grade 3

Extreme Separation

Maternal hypovolemic shock and fetal death will result if without immediate intervention

Complications

• Hemorrhagic Shock

• Couvelaire Uterus

• Disseminated Intravascular Coagulation

• CVA cerebrovascular accident from DIC

• Hypofibrinogenemia

• Renal failure

• Infection

• Prematurity; fetal distress/ demise (IUFD)

Couvelaire Uterus

The bleeding behind the placenta may cause some of the blood to enter the uterine musculature causing the uterine muscles not to contract well once the placenta is delivered

Therapeutic Management / Treatment

• Assess and monitor vaginal bleeding

• Place woman on bedrest in lateral position to prevent pressure on vena cava

• Obtain blood sample for fibrinogen level

• Insert large gauge IV catheter into large vein for fluid replacement

• Monitor FHR and measure maternal vital signs every 5-15 minutes

• Administer oxygen to the mother by mask (limits fetal anoxia)

• Administer IV fluid, plasma, or blood as ordered

Nursing Implementation

• Maintain bedrest

• Careful monitoring: maternal VS, FHT, labor onset/progress, I&O oliguria/anuria, uterine pain, bleeding

• Administer IN fluid, plasma, or blood as ordered

• Prepare for an emergency birth either per vagina or CS

• Observe for associated problems after delivery

Observe for associated problems after delivery

• Poorly contracting uterus (Couvelaire uterus) > postpartal hemorrhage

• Disseminated intravascular coagulation (DIC) > hemorrhage and possibly CVA

• Hypofibrinogenemia > postpartal

  hemorrhage