Abruptio Placenta

Placental Abruption

an uncommon yet serious complication of pregnancy

Placental Abruption

must be considered whenever bleeding is encountered in the second half of pregnancy

Placental Abruption

occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery

Placental Abruption

can decrease or block the baby's supply of oxygen and nutrients and cause heavy bleeding in the mother.

not fully understood yet, risk factors are only identified

etiology of placental abruption

impaired placentation, placental insufficiency, intrauterine hypoxia, uteroplacental underperfusion

etiologic risk factors identified for placental abruption

impaired placentation

Refers to abnormal development or implantation of the placenta in early pregnancy

placental insufficiency

The placenta cannot deliver enough oxygen and nutrients to the fetus

intrauterine hypoxia

(Refers to low oxygen levels within the uterus, affecting the fetus

uteroplacental underperfusion

(Refers to reduced blood flow from the uterus to the placenta) are likely the key mechanisms causing abruption.

10–15%.

Recurrence risk after one ep of placental abruption

up to 25%

Recurrence risk after two ep of placental abruption

HTN, Trauma, smoking & cocaine, multiparity, advanced maternal age, previous hx

risk factors of placental abruption

HTN

most significant risk factor for placental abruption

HTN, smoking, drinking alcohol, cocaine and drug use, prenatal care, short pregnancy intervals, diet/nutritional deficiencies

modifiable risk factors of placental abruption

previous hx, number of past pregnancies, maternal age (>35), previous surgeries, multiple gestation, PROM, inherited thrombophilia

non-modifiable risk factors of placental abruption

last trimester, in the last few weeks before birth

most likely the occurrence of the s/sx of placental abruption

vaginal bleeding, abdominal & back pain, uterine tenderness/rigidity, uterine contractions, fetal distress, fainting/dizziness, decreased fetal movement, blood in amniotic fluid

common s/sx of placental abruption

Vaginal bleeding

Most common symptom

Vaginal bleeding

it can vary greatly and doesn’t necessarily indicate how much of the placenta has separated from the uterus

Abdominal pain and back pain

common s/sx that beings suddenly

Faint feeling or dizziness

can be a sign of blood loss or hypovolemic shock

clinical diagnosis

how to diagnose abruptio placentae

Sudden, severe, continuous abdominal pain.

Hard, rigid (“woody”) uterus.

Dark, light vaginal bleeding, possibly heavy with clotting issues.

Disproportionate shock: weak or undetectable pulse, low blood pressure, rapid breathing, pale, cold, clammy skin, anxiety.

Signs of fetal distress or absent fetal heart tones.

Uniformly red amniotic fluid after membrane rupture.

clinical s/sx of placental abruption

Fetal heart monitoring

used to assess the baby’s well-being and may reveal signs of fetal distress, such as absence of fetal heart tone, which can indicate reduced oxygen delivery due to placental separation.

Complete blood count

helps evaluate the mother’s blood status. Low hemoglobin levels may suggest significant blood loss, while a decreased platelet count could lead to a developing clotting disorder like disseminated intravascular coagulation

Blood and Rh typing

determine the mother’s blood group and Rh factor, which are important in managing potential complications. Knowing the blood group is important in case a transfusion is needed and determining Rh factor is especially for Rh-negative mothers.

Prothrombin time and Partial thromboplastin time

it measures how long it takes blood to clot, abnormal results can indicate impaired coagulation

Serum fibrinogen levels and fibrin-split products

key indicators of clotting function, low fibrinogen and elevated fibrin degradation products are sensitive markers for disseminated intravascular coagulation, suggesting significant clot formation and breakdown in the body.

Pelvic ultrasonography

used to look for placental detachment or internal bleeding, helping to visualize any clots.

Kleihauer-Betke test

used in Rh-negative mothers to identify the presence of fetal red blood cells in the maternal circulation, helping to calculate the correct dose of Rh immunoglobulin needed to prevent Rh sensitization

Shock, as a result of blood loss.

Kidney and other organ failure caused by a significant loss of blood.

Coagulopathy.

Severe hemorrhage, increasing the necessity of a blood transfusion.

Hysterectomy (In cases of uncontrollable uterine bleeding - Rare).

Premature delivery.

Cesarean Section.

Increased risk of adverse cardiovascular events.

Maternal death.

maternal effects of placental abruption

Growth restrictions due to a lack of nutrients.

Insufficient oxygen.

Premature birth.

Stillbirth.

Fetal demise.

fetal effects of placental abruption

Cesarean Section

primary course of treatment

Cesarean Section

done when there is significant placental abruption accompanied by fetal distress

Cesarean Section

done when birth is imminent

Cesarean Section

This rapid surgical delivery minimizes the risk of stillbirth and neonatal morbidity associated with prolonged fetal hypoxia.

Manage fluids and circulatory volume carefully during surgery.

Postoperatively, monitor for hemorrhage and clotting issues.

Ensure a neonatal team is present for newborn care.

addtl management in CS delivery for placental abruption

Hysterectomy

a critical last-resort intervention

Hysterectomy

done when the mother develops disseminated intravascular coagulation (DIC), leading to uncontrollable uterine bleeding

Hysterectomy

done when conservative measures (uterotonic agents, uterine packing, blood product replacement) fail to control hemorrhage.

Hysterectomy

a critical procedure to prevent maternal exsanguination and save a woman's life when uterine preservation is insufficient, in coordination with the care team.

iv fluids, oxygen inhalation, fibrinogen determination

medical/supportive managements

IV Fluids

Rapid fluid resuscitation with large-bore IV catheter to counteract hypovolemia.

Oxygen Inhalation

High-flow oxygen via face mask to improve fetal oxygenation.

Fibrinogen Determination

Serial monitoring to detect DIC early and guide management.

tachycardia, hypotension, pallor, and altered consciousness

signs of hypovolemic shock

Uterine activity becomes frequent and strong and changes in pain

sign of worsening placental separation and fetal compromise

onset, amount, type of bleeding

Helps determine the severity and progression of the abruption

Abdominal or back pain

typically sharp and sudden

Reduced perfusion due to hypovolemia

may lead to acute kidney injury

Urine output <30 mL/hr

critical sign of possible renal failure or kidney injury d/t hypovolemia

Disseminated Intravascular Coagulation

DIC meaning

Disseminated Intravascular Coagulation

life-threatening clotting disorder

left lateral position

Improves uteroplacental blood flow and reduces pressure on the inferior vena cava, enhancing maternal and fetal oxygenation

two large-bore peripheral IV lines.

inserted to ensure rapid access for fluid and blood product administration

Crystalloid or colloid solutions

Restores circulating volume

Crystalloid

usually first-line to restore circulating volume

 analgesia

given for pain management; Relieves discomfort, promotes maternal comfort, and reduces stress response.

hard, rigid, woody uterus

defined uterus

painful abruptio, painless previa

when uterus is contracted, there is no FHT

abruptio vs previa

medical/supportive management

management used only to support recovery and prevent further blood loss

iv fluids

used to maintain adequate maternal pressure and tissue perfusion

oxygen inhalation

used especially when fetal distress is observed