Abruptio placenta is premature separation of the normally implanted placenta after the 20th week

of pregnancy, typically with severe hemorrhage.

Two types of abruption placentae:

Concealed hemorrhage - the placenta separation centrally, and a large amount of blood is
accumulated under the placenta.

External hemorrhage – the separation is along the placental margin, and blood flows under the
membranes and through cervix.

Risk Factors:

1. Uterine anomalies
2. Multiparity
3. Preeclampsia
4. Previous cesarean delivery
5. Renal or vascular disease
6. Trauma to the abdomen
7. Previous third semester bleeding
8. Abnormally large placenta
9. Short umbilical cord

Clinical Manifestations:

 Class 0: asymptomatic. Diagnosis is made retrospectively by finding an organized blood

clot or a depressed area on a delivered placenta.
  Class 1: mild and represents approximately 48% of all cases. Characteristics include the
following:
o No vaginal bleeding to mild vaginal bleeding

o Slightly tender uterus

o Normal maternal BP and heart rate

o No coagulopathy

o No fetal distress

 Class 2: moderate and represents approximately 27% of all cases. Characteristics include
the following:
o No vaginal bleeding to moderate vaginal bleeding

o Moderate-to-severe uterine tenderness with possible tetanic contractions

o Maternal tachycardia with orthostatic changes in BP and heart rate

o Fetal distress

o Hypofibrinogenemia (ie, 50-250 mg/dL)

 Class 3: severe and represents approximately 24% of all cases. Characteristics include
the following:
o No vaginal bleeding to heavy vaginal bleeding

o Very painful tetanic uterus

o Maternal shock

o Hypofibrinogenemia (ie, <150 mg/dL)

o Coagulopathy

o Fetal death

Lasting effects
On the mother:

 A large loss of blood or hemorrhage may require blood transfusions and intensive care
after delivery. 'APH weakens for PPH to kill'.
  The uterus may not contract properly after delivery so the mother may need medication to
help her uterus contract.
 The mother may have problems with blood clotting for a few days.
 If the mother's blood does not clot (particularly during a caesarean section) and too many
transfusions could put the mother into disseminated intravascular coagulation (DIC) due
to increased thromboplastin, the doctor may consider a hysterectomy.
 A severe case of shock may affect other organs, such as the liver, kidney, and pituitary
gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication.
 In some cases where the abruption is high up in the uterus, or is slight, there is no
bleeding, though extreme pain is felt and reported.

On the baby:

 If a large amount of the placenta separates from the uterus, the baby will probably be in
distress until delivery and may die in utero, thus resulting in a stillbirth.
 The baby may be premature and need to be placed in the newborn intensive care unit. He
or she might have problems with breathing and feeding.
 If the baby is in distress in the uterus, he or she may have a low level of oxygen in the
blood after birth.
 The newborn may have low blood pressure or a low blood count.
 If the separation is severe enough, the baby could suffer brain damage or die before or
shortly after birth.