Abp

Al Quds university
facility of health professions

nursing and midwifery department
abruptio placenta
prepared by St. laith Yaghi
21810333
presented to: Mrs. Marwa Rabee

outline
• Anatomy & physiology
• Definition
• Causes
• S&S
• Diagnoses
• Types
• Grades
• Complications
• Treatment
• Care plan
Anatomy & physiology
• The placenta forms where the impro attaches to the uterine wall
• it forms from the mother and the fetus
• Permits Gas and Nutrient exchange
• it has two layers:
• Maternal: decidua basalis
• Fetal: Chorin
• The gases and nutrients move back and forth between the decidua
basalis and the fetal veins
• by diffusion through the tissue layer of the thin chorionic villi
Definition
• Abruptio placentae is the premature separation of a normally implanted placenta from
the uterine wall
• Separation of the uterine wall and the decidua basalis
• Premature separation, the leading cause of perinatal mortality, is considered a

catastrophic event because of the severity of the resulting hemorrhage
• The incidence of abruptio placentae is 0.5% to 1.0% of all pregnancies but it accounts for
10% to 15% of all perinatal deaths (Cunningham et al., 2010)
Causes
• The cause of abruptio placentae is largely unknown
• Risk factors associated with placenta abruption include:
• Previous abruption
• increased maternal age
• increased parity
• cocaine abuse
• trauma
• maternal hypertension
Signs and symptoms
• Sharp, stabbing pain high in the uterine fundus with or without
contractions.
• Sudden onset
• Abdominal tenderness.
• Heavy bleeding may or may not be externally (concealed).
• Changes in the fetal heart.
Diagnoses
• Diagnoses is made by imagining:
• U/S does the job and it shows Retroplacental collection of blood.
• Blood or blood-stained amniotic fluid comes out of the vagina
• Hemoglobin level and fibrinogen level. These tests are performed to
rule out disseminated intravascular coagulation.
Types
• Abruptio placentae is subdivided into three types:
• Marginal:
• In this case the placenta separates at its edges, the blood passes between the fetal
membranes and the uterine wall, and the blood escapes vaginally (also called marginal
sinus rupture).
• Central:
• In this situation, the placenta separates centrally, and the blood is trapped between the
placenta and the uterine wall. Entrapment of the blood results in concealed bleeding.
• Complete:
• Massive vaginal bleeding is seen in the presence of total separation.
CONT..
Grades
• Abruptio placentae may also be graded according to the severity of
clinical and laboratory findings as follows:
• Grade 1:
• Mild separation with slight vaginal bleeding. FHR pattern and maternal blood pressure
unaffected. Accounts for 40% of abruptions.
• Grade 2:
• Partial abruption with moderate bleeding. Significant uterine irritability is present.
Maternal pulse may be elevated although blood pressure is stable. Signs of fetal
compromise evident in FHR. Accounts for 45% of abruptions.
• Grade 3:
• Large or complete separation with moderate to severe bleeding. Maternal shock and
painful uterine contractions present. Fetal death common. Accounts for about 15% of
abruptions.
CONT..
• In severe cases of central abruptio placentae, the blood invades the
myometrial tissues between the muscle fibers. This occurrence
accounts for the uterine irritability that is a significant sign of abruptio
placentae. If hemorrhage continues, eventually the uterus turns
entirely blue because the muscle fibers are filled with blood.
• After birth the uterus contracts poorly.
• This condition is known as a Couvelaire uterus and frequently
necessitates hysterectomy
complications
• Maternal:
• Hypovolemic shock due to the bleeding
• This may lead to death
• Renal failure
• DIC (disseminated intravascular coagulation)
• Fetal:
• Intrauterine hypoxia
• Asphyxia
• Increase risk of premature birth
Treatment
• After establishing the diagnosis, immediate priorities are maintaining the
cardiovascular status, by giving ivf and blood products
• the delivery plan depends on the condition of both the mother and the
baby:
• If the mother and the child is stable (mild separation):
• we could closely monitor the mother and the baby until the right time for delivery.
• If the mother and child both are unstable:
• Delivery the is the option here
• If there was sever hemorrhage and fetal comprise:
• Emergency C/S may be the choice
Care plan
• Nursing assessment:
• Assess for signs of shock, especially when heavy bleeding occurs.
• Assess if the bleeding is external or internal.
• Monitor contractions if separation occurs during labor
• Obtain baseline vital signs.
• Assess for the time the bleeding began, the amount and kind of
bleeding, and interventions done when bleeding occurred if it
started before admission.
• Assess for the quality of pain.
CONT..
• Nursing intervention:
• Place the woman in a lateral, not supine position to avoid pressure
in the vena cava.
• Assess uterine irritability, abdominal pain and rigidity.
• Monitor fetal heart sounds.
• Avoid performing any vaginal or abdominal examinations to
prevent further injury to the placenta.
• Measure intake and output.
• Administer analgesics as indicated.
References
• P. Ladewig, M. London, M. Davidson - Contemporary Maternal-
Newborn Nursing Care (2014)

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Al Quds university

facility of health professions

prepared by St. laith Yaghi

presented to: Mrs. Marwa Rabee

• Premature separation, the leading cause of perinatal mortality, is considered a

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