26/03 Abruption: Definitions, Risks, and Management - look back at slides

Definition of Abruption

• Abruption refers to the premature separation of the placenta from the uterine wall during pregnancy.

• This condition can lead to maternal and fetal complications, including bleeding, which may be concealed or revealed.

Mechanics of Abruption

• Bleeding is caused by the formation of a hematoma beneath the placenta due to separation.

• Concealed bleeding occurs if there are no leakages from the edges of the placenta.

• Degrees of separation can vary:

  • Partial separation may reveal some bleeding.

  • Complete separation may lead to significant hemorrhage.

Impact on Fetus

• Reduced oxygen and nutrient supply to the fetus resulting from placental abruption can lead to:

  • Growth restriction or being small for gestational age.

  • Possible intrauterine death in severe cases.

• Symptoms may not always be evident, leading to the potential for late diagnosis.

Risk Factors for Abruption

• Previous history of placental abruption increases likelihood in subsequent pregnancies.

• Other significant risk factors include:

  • Smoking and substance abuse.

  • Chronic hypertension and pre-eclampsia.

  • Any history of bleeding in previous pregnancies.

  • Certain ethnicities are at increased risk.

Symptoms and Diagnosis

• Symptoms can include:

  • Abdominal pain (distinguishes it from placenta previa).

  • Vaginal bleeding may or may not be present.

  • Signs of trauma (e.g., from accidents).

• Patients must be carefully evaluated for:

  • High blood pressure episodes, even if normal during the assessment.

  • Severity of pain and physical assessments of the uterus.

Assessment Methodology

• To diagnose suspected abruption:

  • Conduct in-person evaluations for those reporting symptoms or trauma.

  • Perform CTG to monitor fetal heart rate.

  • Utilize Doppler sonography to assess blood flow through uterine structures in severe cases.

Management of Abruption

• Immediate medical management is crucial if symptoms suggest significant bleeding or fetal distress.

• Decisions regarding transfer to higher-level care facilities must be made with consideration of:

  • Severity of symptoms.

  • Risks associated with transportation.

• Patients involved in accidents during pregnancy must be evaluated, especially post-20 weeks.

Follow-Up and Further Testing

• Histological examination of the placenta post-delivery may provide insights into the incidence of abruption.

• Observation and monitoring of fetal movement patterns post-incident are critical for identifying complications.

• Any signs of increased maternal or fetal distress require prompt intervention to prevent cardiovascular collapse or shock.

Placental abruption is defined as the premature separation of the placenta from the uterine wall during pregnancy, leading to bleeding caused by this separation.

Pathophysiology of Placental Abruption

• Abruption results in a hematoma formation beneath the placenta due to separation, causing bleeding.

• The degree of separation can vary, resulting in:

  • Partial separation: May reveal some bleeding.

  • Complete separation: Can lead to significant hemorrhage.

Risk Factors for Placental Abruption

• Previous history of placental abruption increases the likelihood in future pregnancies.

• Other significant risk factors include:

  • Smoking and substance abuse

  • Chronic hypertension and pre-eclampsia

  • A history of bleeding in previous pregnancies

  • Certain ethnicities are at increased risk.

Symptoms of an Acute Episode

• Symptoms may include:

  • Abdominal pain, which helps differentiate it from placenta previa.

  • Vaginal bleeding may or may not be present.

  • Signs of potential trauma from accidents.

• Severe or profuse symptoms require immediate attention.

Follow-Up

• Remember to monitor for any signs of maternal or fetal distress which can indicate the need for prompt intervention.