Case study

Slide 1: TITLE
Slide 2: INTRO OF THE GROUP (Leader, Assistant Leader, Sec, and
Member)
3: Introduction
One of the most considered as a crucial factor for pregnancy
bleeding is placental abruption. It typically manifests as a
painful combination of uterine contractions, vaginal bleeding,
and bleeding. Depends primarily on gestational age, fetal weight,
and the degree of abruption, the perinatal mortality rate ranges
from 20 to 67%. Since placental abruption accounts for about half
of perinatal deaths, it is also a significant cause of pregnancy
complications.
Alcohol, cocaine usage, and cigarette smoking are just a few of
the factors that have been linked to an increased risk of
placental abruption. Recent studies have shown that women with
thrombophilic pregnancies and those who have a family history of
venous thromboembolism are more likely to experience placental
abruption . The majority of cardiovascular disease risk variables
are believed to be associated to placental abruption risk
factors.

5: Title of the PROBLEM ( Abruptio Placenta)

6: Definition

 Abruptio Placenta is the premature separation of a normally

implanted placenta occurring after the 20th week of
gestation when the clinical and pathologic criteria are met.
Though it is one of the causes of third trimester bleeding,
it may also complicate labor. Hypertonic uterine
contractions in labor or sudden uterine decompression may
precipitate abruption placenta.
 Placental abruption is defined as partial or complete
premature separation of a normally implanted placenta with
hemorrhage into the decidua basalis

Classification
As to extent:
 1. Partial
 2. Total
 As to onset:
1. Acute abruption
2. Chronic abruption completely without delivery.
As to type of bleeding:
1. External
2. Concealed
3. Marginal sinus rupture

7: Synonyms

 Accidental hemorrhage
 premature separation of the placenta
 placental apoplexy

8: Causative Organism

 None
 The cause of Abruptio Placenta is still unknown
9: Risk Factors:  
Factors that can increase the risk of placental abruption
include:

- Modifiable
 Lifestyle
- Use of narcotics such as cocaine
- Use of Cigarettes (Smoking)
- Alcohol Drinking
- Non-Modifiable

 Older maternal age (Advanced maternal age and parity)

 Hypertension (pregnancy-related or chronic)
 Placental ischemia (ischemic placental disease) manifesting
as intrauterine growth restriction
 Intraamniotic infection (Chorioamnionitis or intraamniotic
infection is an acute inflammation of the membranes and
chorion of the placenta, typically due to ascending
polymicrobial bacterial infection in the setting of membrane
 rupture.)
 Vasculitis or Other vascular disorders
 Prior placental abruption
 Abdominal trauma
 Acquired maternal thrombotic disorders (Thrombophilias)
 Maternal Cigarette Smoking or Tobacco use
 Premature rupture of membranes, particularly in women who
have polyhydramnios
 Short umbilical cord late in labor as the fetus descends.
 Sudden decompression of the uterus in cases of over
distention, loss of amniotic fluid or after delivery of the
first twin
 Uterine anomalies or tumors like in retroplacental myomas.
10: Clinical Manifestations
Severity of symptoms and signs of placental abruption depends on
the degree of separation and blood loss.

 uterine bleeding sometimes concealed hemorrhage

 Vaginal bleeding, although there might not be any
 Abdominal pain
 Uterine contractions & Uterine Tenderness- may be
generalized or localized to the site of placental detachment
 Uterine hypertonus ( when the uterus does not relax between
contractions)
 Back pain
 Fetal distress
 Dead fetus
 Idiopathic premature labor ( births before 37 weeks of
pregnancy)
11: Diagnostic Tests
test that may determine the possible causes of vaginal bleeding:

 Physical examination
 Fetal heart rate monitoring
 coagulation blood tests
 Ultrasound
Evaluation for placental abruption can include the following:

 Fetal heart monitoring

  CBC (complete blood count)
 Blood and Rh typing
 PT/PTT (prothrombin time/partial thromboplastin time)
 Serum fibrinogen and fibrin-split products (the most
sensitive indicator)
 Pelvic ultrasonography
 Kleihauer-Betke test if the patient has Rh-negative
blood—to calculate the dose of Rho(D) immune globulin
needed
12: Pathophysiology
-hindi kasali
13:!Management:
 Objective Management:
To control the hemorrhage and deliver the fetus as soon as
possible

Once the placenta has separated from the uterus, it cannot be

reconnected or repaired. A healthcare provider will recommend
treatment based on:

• The severity of the abruption.

• How long the pregnancy is/gestational age of the fetus.
• Signs of distress from the fetus.
• Amount of blood you’ve lost.

Mild placental abruption

If the pregnant woman has mild abruption at 24 to 34 weeks of
pregnancy, she need careful monitoring in the hospital. If tests
show that the mother and baby are doing well, the provider may
give treatment to try to keep pregnant for as long as possible.
The provider may want the mother to stay in the hospital until
it give birth. If the bleeding stops, she may be able to go home.
Ift the pregnan woman has mild abruption at or near full term,
the provider may recommend inducing labor or c-section. She may
need to give birth right away if:

 The abruption gets worse and you are having increased pain.
  You are bleeding heavily or show signs in your blood tests
of severe anemia.
 Your baby has heart rate changes that indicate it is having
problems.
Moderate or severe placental abruption
If the pregnant woman has a moderate to severe abruption,
she is in a medical emergency and usually need to give birth
right away. Needing to give birth quickly may increase
chances of having a c-section.

If the mother lose a lot of blood due to the abruption, she

may need a blood transfusion. An emergency c-section may be
needed to save the mother and baby. It’s very rare, but if
she have heavy bleeding that can’t be controlled, she may
need to have her uterus removed by surgery (hysterectomy). A
hysterectomy can prevent deadly bleeding and other problems
in the body. But it also means that you can’t get pregnant
again in the future.

 Medical Management
- Medicines may be given to stop contractions if the baby is not
ready to be born.
- Steroids may also be given to help the baby's lungs develop
faster if early delivery may happen.

 Surgical Management
-LSCS Procedure

14: Complications
Placental abruption can cause life-threatening problems for both
mother and baby.

Mother

 Hemorrhage
  coagulation failure
 acute renal failure
 acute corpulmonale
 Sheehan’s syndrome and post transfusion hepatitis
 Maternal oliguria and shock
Baby

 Growth problems
 Preterm birth
 Still birth

15: Signs that AP is under control

None
16: Prevention