Abruptio Placentae

Cecille Joyce D. Marzo

BSN-4A Group-1
 INTRODUCTION

ANATOMY AND
PATHOPHYSIOLOGY

Table of Contents SIGNS AND SYMPTOMS

CAUSES AND RISK

FACTORS

DIAGNOSIS

MANAGEMENT AND
TREATMENT
 Placental Abruption
Placental abruption is a complication of pregnancy that happens
when the placenta separates from your uterus before delivery. The
placenta is a temporary organ that connects a growing fetus to your
uterus during pregnancy. It attaches to the wall of your uterus,
usually on the top or side and acts as a lifeline that gives nutrients
and oxygen to the fetus through the umbilical cord. The placenta
also removes waste from the fetus's blood

In placental abruption, the placenta may completely detach or

partially detach. This can decrease the amount of oxygen and
nutrients to the fetus and cause heavy bleeding in the birthing parent.
Placental abruption is a serious condition that requires medical
treatment.

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 Anatomy and
Pathophysiology
The uterus is a secondary sex organ.
Secondary sex organs are components of the
reproductive tract that mature during puberty
under the influence of sex hormones
produced from primary sex organs (the
ovaries in females and the testes in males).

The uterus is a thick-walled muscular organ

capable of expansion to accommodate a
growing fetus. It is connected distally to the
vagina, and laterally to the uterine tubes.

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 Anatomy and
Pathophysiology
The uterus has three parts;

Fundus – top of the uterus, above the entry

point of the uterine tubes.
Body – usual site for implantation of the
blastocyst.
Cervix – lower part of uterus linking it with
the vagina. This part is structurally and
functionally different to the rest of the uterus.

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 The process of placental abruption begins with uterine vasospasm followed by
relaxation, and subsequent venous engorgement and arterial rupture (decidual
arteries).

A hematoma forms which may initially be concealed but with expansion of the
hematoma, progressive placental separation occurs.

When there has been intravasation of blood into the myometrium, the uterus
becomes purplish in color - The so called Couvelaire uterus.

The infiltration of blood between muscle fibers causes a tonic contraction which
makes the uterus “woody hard” and tender.

The increase in intra-uterine pressure compromises the placental circulation, adding

to the fetal hypoxia which has already started due to the placental separation.
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Types of Placental
Abruption
 Types of Placental Abruption
• A partial placental abruption occurs when the placenta does
not completely detach from the uterine wall.
• A complete or total placental abruption occurs when the
placenta completely detaches from the uterine wall. There is
usually more vaginal bleeding associated with this type of
abruption.
• Revealed placental abruptions have moderate to severe vaginal
bleeding that you can see.
• Concealed placental abruptions have little or no visible vaginal
bleeding. Blood is trapped between the placenta and uterine wall.

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 DIFFERENCE BETWEEN PLACENTAL
ABRUPTION AND PLACENTAL PREVIA
In placenta previa, the placenta is covering all
or part of the birthing parent's cervix. It's also called
low-lying placenta. Think of it as an obstacle that’s
blocking the exit from the uterus. Even though the
placenta is in a complicated position, it’s still attached
to the uterus. When the placenta detaches from the
uterus, this is a placental abruption. Both conditions
can cause vaginal bleeding during pregnancy and labor.

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 What are the effects of Placental Abruption?
Placental abruption can be life-threatening to the fetus and sometimes
to you. Complications from a placental abruption include:

For baby: For birthing parent:

• Premature birth. • Blood loss.

• Low birth weight. • Blood clotting issues.
• Growth problems. • Blood transfusion.
• Brain injury from lack of oxygen. • Hemorrhage.
• Stillbirth. • Kidney failure.

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Signs and Symptoms
Each person can have different symptoms of placental
abruption. However, the most common symptom is vaginal
bleeding with cramping during the third trimester of
pregnancy. Symptoms or signs can also include:

• Abdominal pain.
• Uterine contractions that are longer and more intense than
average labor contractions.
• Uterine tenderness.
• Backache or back pain.
• Decreased fetal movement.
Signs and Symptoms
Vaginal bleeding can vary and is not an indication of how
much the placenta has separated. In some instances, there
could be no visible bleeding because the blood is trapped
between the placenta and the uterine wall. Pain can range from
mild cramping to strong contractions and often begins
suddenly.

These symptoms can resemble other pregnancy conditions.

Always consult with your healthcare provider for a diagnosis.
 What are the causes?
The cause of placental abruption is often unknown. Certain lifestyle
choices or abdominal trauma can increase your risk for placental
abruption.

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Risk Factors HIGH BLOOD PRESSURE
(HYPERTENSION),
GESTATIONAL DIABETES
OR PREECLAMPSIA.
TRAUMA OR INJURY TO
YOUR UTERUS (LIKE A
CAR ACCIDENT, FALL OR
BLOW TO THE STOMACH).
MULTIPLE GESTATIONS
(TWINS OR TRIPLETS).

PREVIOUS PLACENTAL IF YOU SMOKE OR HAVE A

ABRUPTION. HISTORY OF DRUG USE.
Risk Factors
UTERINE FIBROIDS.

SHORT UMBILICAL CORD.

THROMBOPHILIA (A
BLOOD CLOTTING
DISORDER).
PREMATURE RUPTURE OF
MEMBRANES (THE WATER
BREAKS BEFORE THE
MATERNAL AGE 35 OR FETUS IS FULL TERM).
GREATER. RAPID LOSS OF THE
AMNIOTIC FLUID.
 Diagnosis and Tests
Placental abruption is diagnosed through an exam and monitoring. You may be admitted
to the hospital depending on the severity of the abruption or you may be able to rest at
home. Your healthcare provider will:
o Ask how much bleeding has occurred.
o Ask where you feel pain and how intense the pain is.
o Ask when symptoms started.
o Monitor your blood pressure.
o Monitor the fetal heart rate and movement.
o Monitor your contractions.
o Use ultrasound to locate the bleeding and to check the
fetus.
o Recommend blood or urine tests.

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 There are typically three grades of placental abruption a healthcare provider will
diagnose:

Grade 1: Small amount of bleeding, some uterine contractions, and no signs of

stress to you or the fetus.
Grade 2: Mild to moderate amount of bleeding, some uterine contractions, and
signs of fetal stress.
Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions
that do not relax, abdominal pain, low blood pressure, and fetal death.

It is important to discuss any symptoms or changes in symptoms with your

healthcare provider.

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 Management & Treatment
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.

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 Management & Treatment
If the fetus isn't close to full term:

• If it's too soon for your baby to be born and your

abruption is mild, you will be closely monitored until
you reach 34 weeks of pregnancy. If the fetal heart rate
is normal and you're not bleeding, your healthcare
provider may allow you to go home to rest. They may
give you medication to help with fetal lung
development.
• If your abruption is severe and the health of you or the
fetus are at risk, immediate delivery may be necessary.
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 Management & Treatment
Placental abruptions are typically unpreventable. But you can
reduce your risk by:

• Not smoking or using drugs.

• Keeping your blood pressure at a healthy level.
• Managing diabetes.
• Taking health and safety precautions like wearing a seat belt.
• Reporting any abdominal trauma to your healthcare provider.
• Talking to your healthcare provider about any vaginal
bleeding.

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thank you!