ABRUPTIO PLACENTA
when the placenta does
WHAT IS ABRUPTIO
PLACENTA?
- Premature Separation of
placenta from the
implantation site
- Occurs after the 20th week of
pregnancy
- The placenta has detached
from the wall of the uterus,
either partly or totally.
Other names:
- Premature separation of
placenta
- Accidental hemorrhage
- Ablatio Placenta
- Placental Abruption
SIGNS & SYMPTOMS
- Painful vaginal bleeding
- Dark red bleeding
- Uterine
tenderness/contractions
- Severe abdominal Pain
- Concealed bleeding
(retroplacental)
- Rigid abdomen
TYPES OF ABRUPTIO
PLACENTA
 Partial Abruption- occurs
not completely detach
from the uterine wall
 Complete or Total
Abruption- occurs when
the placenta completely
detaches from the uterine
wall
LABORATORY TESTS
- CBC- may reveal anemia ad
thrombocytopenia
- Prothrombin time test-
imperative to know if this is
abnormal as a cesarean
section may be required
- Fibrinogen level test- aim to
keep the fibrinogen level
above 100mg/dl because
pregnancy is associated with
hyperfibrinogenemia.
- Ultrasound- May reveal a
retroplacental hematoma and
fetal heart can also be seen
as present or not.
PHARMACOLOGIC
MANAGEMENT
 Corticosteroids-
corticosteroids are given
when preterm delivery
(less than 37 weeks) is
expected. They are
associated with a
decreased risk of neonatal
 respiratory distress,
necrotizing enterocolitis,
and intracranial
hemorrhage. The two
most used medications
are betamethasone and
dexamethasone. While
they should be considered
if the patient is preterm
with an abruption,
delivery should not be
delayed for their
administration.
MEDICAL MANAGEMENT
 Intravenous therapy- This
would be prescribed by the
physician to replace
the blood that was lost
during bleeding.
 Blood Transfusions- PRBC
to correct anemia
 Attach external monitoring
equipment- To monitor the
uterine contractions and
record fetal heart sounds, an
external equipment is
preferred than the internal
monitoring equipment.
SURGICAL MANAGEMENT
 Vaginal Delivery- preferable
for a fetus that has demised
secondary to placental
abruption. Dependent on
patient’s hemodynamic
stability or contraindications
to vaginal birth.
 Cesarean Delivery- may be
required to save both mother
and child. Rapid access to
uterus and its vasculature.
NOTE: Cesarean
hysterectomy may be
required for uncontrollable
hemorrhage.
NURSING MANAGEMENT
- Assess baseline vital signs
especially the blood
pressure, HR and Oxygen
Saturation. The physician
would order monitoring of
the blood pressure every 5-
15 minutes.
- Assess fetal heart sounds to
monitor the wellbeing of the
fetus.
- Monitor uterine contractions
to establish the progress
of labor of the mother.
- Weigh perineal pads used
during bleeding to calculate
the amount of blood lost.
- Strict I & O
- Assist the woman in a side
lying position when bleeding
occurs.