Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.

1. Audit
Abruptio Placenta
BY
MUKESH SAH,MD
POST GRADUATE MEDIAL INTERN
GOODSAM MEDICAL CENTER

2. General Data
CN
36y/o
Married
CAB CITY, NUEVA ECIJA
3/11/1981
Housewife
High school graduate
Unemployed

3. Chief Complaint
O Hypogastric pain

4. History of Present Illness
O 2 hours PTA - patient had hypogastric pain associated with
vaginal bleeding and blurring of vision.
O Persistence of sign and symptoms prompted patient to seek
consult to our institution and was subsequently admitted.

5. Past Medical History
(-) Hypertension
(-) DM
(-) Bronchial Asthma
(-) History of Trauma
(-) Use of Alcohol and Tobacco
(-) Previous Surgery
(-) Allergies
(-) Immunization

6. Family History
(-) Hypertension
(-) DM
(-) Bronchial Asthma
(-) Cancer

7. OB History
O Menarche- 10 y/o
O Interval - regular
O Duration- 5days
O Amount- 4pads/day
O (-) Dysmenorrhea
O Coitarche : 23 y/o
O Sexual partner: 1
O Family Planning:
Injectable(2007)
O Prenatal check
Up:9xRHU

8. OB History
O LMP: December 5, 2016
O EDC: September 11, 2017
O AOG: 36 4/7 weeks
O G1 2004 R1MC TERM MALE NSD ALIVE
O G2 2007 R1MC TERM FEMALE NSD ALIVE

9. Physical Examination
O Skin: no pallor, no cyanosis, no jaundice
O HEENT: normocephalic, pink conjunctiva, anicteric sclera, no
palpable cervical lymph node
O Chest: clear breath sounds, symmetrical chest expansion
O Cardiovascular: adynamic precordium, regular heart rate
and rhythm
O Breast: Symmetrical, no discharge, no mass

10. Physical Examination
O Abdomen: globular, firm, non-tender
O Rectum: no hemorrhoids, no skin tags
O Internal Examination: cervix 2 cm dilated, beginning
effacement, station -3,cephalic, intact bow, (+) show
O Extremities: no edema, no cyanosis
O Neurological: No neuro deficit, GCS 15

11. Physical Examination
O Fetal Heart tone:150bpm
O Fundic Height: 28 cm
O EFW: 2,635gms
O Uterine contraction Intensity: mild to mod
Duration: 1-2 mins
Interval: 10-15 mins
O Leopold’s Maneuver LM1: binodular mass
LM2: fetal back right
LM3: Ballotable
LM4: Convergent

12. Pertinent Findings
O Hypogastric pains
O Blurring of vision
O Vaginal bleeding-moderate
O Elevated BP (150/110)

13. Admitting Diagnosis
G3P2 Pregnancy Uterine 36 2/7 weeks
AOG,
Cephalic in Beginning Labor,
CVHD with superimposed pre-eclampsia

14. Day 1 of Admission
8:40am
O Admitted at Labor room
O Diagnostics done
-Cbc typing
-Urinaysis
-HbsAg
-VRDL/RPR
-SGOT/SGPT
IVF: D5LRS 1L x 20gtts/min
Monitored VS, FHT and Progress of Labor
VS: BP-150/110mmhg CR-81bpm RR-22cpm T-37.1C

15. Day 1 of Admission
O Tx: MgS04
O Nifedipine
O Methyldopa
O IE: Cervix 2cms dilated, beginning effacement, cephalic, st -
3 (+)BOW, (+)minimal vaginal bleeding

16. Day 1 of Admission
O 8:15 pm
O To OB ward(Medicare) under blue service
O Complete bed rest without BRPS
O Continue oral meds

17. Urea Result Normal
Crea 3.18 2-8
SGOT 49 35-71
SGPT 21 8-38
NA 133.4 135-148
K 3.69 3.5-5.3
Cl 108.90 98-107
Ca 1.21 1-1.32
LDH 525 0-480

18. Day 2 of Admission
O 7:40am
O BP130/90
O TX: Hydralazine 5mg iv
O Methyldopa 250mg tab q8
O Calcium tab od
O Nifedipine 10mg tab q8
O Monitor BP and record q1
O Complete bed rest

19. Day 2 of Admission
12:20nn
O To OR now
O For ‘E’ LTCS I (abruptio placenta)
O Secured consent
O Notify OR/Anes/Pedia
O For AbdominoPerineal Prep
O Monitor VS; insert BT line PNSS 1L x 30gtts/min
O Secure 2 Units PRBC properly typed and
crossmatched then transfuse once available
O Cefuroxime 1.5g IV

20. Day 1 of Admission
CBC typing (8/18/2017)
Parameter Result N Paramete
r
Result N
WBC 16.86x10/
L
4-10 MCV 73.9f/L 80-100
Neutrophils 84.4% 55-65 MCH 23.6 pg 27-34
Lymphocytes
11.4% 25-35 MCHC 320g/L 310-370
Monocytes 3.8% 3-6 RDW-CV 13.2% 11-16
Eosinophils 0.1% 2-4 RDW-SD 39.0 f/L 35-56
Basophils 0.3% 0-1 PLT 244x 10/L 150-450
Rbc 5.12x
10/L
4-5.4 MPV 8.7 f/L 6.5-12
Hbg 121g/L 120-
160
PDW 16.3 9-17
Hct 37.8% 37-47 PCT 0.21% .108-
.282

21. Day 1 of Admission
Urinalysis(8/18/2017)
Color Light Yellow Specific
gravity
1.015
Trasparency Sl Turbid Leucocyte Negative
Bilirubin Negative RBC 7
Urobilinogen Normal Pus Cells 4
Ketones Negative Epithelial
Cells
3
Protein + Hyaline cast 0
Nitrites Negative Bacteria 333
Glucose Negative pH 7.5

22. Operative Findings
O On laparatomy (+) Ascites brownish in color, exposed lower
uterine segment formed. LTCS was done. Delivered to a
Stillborn Baby Boy in cephalic presentation. Amniotic fluid
was reddish in color and adequate. Placenta
posterofundally located was 75% detached with 500cc of
blood clots. Both tubes and ovaries were grossly normal.
Post-operatively noted uterus with Couvelaire, posteriorly
and anteriorly.

23. 1st Post-Op Day
CBC typing (8/20/2017)
Parameter Result N Paramete
r
Result N
WBC 23.1x
10/L
4-10 MCV 76.7f/L 80-100
Neutrophils 87% 55-65 MCH 25.2 pg 27-34
Lymphocytes
6.7% 25-35 MCHC 328g/L 310-370
Monocytes 5.8% 3-6 RDW-CV 17.1% 11-16
Eosinophils 0.3% 2-4 RDW-SD 47.9 f/L 35-56
Basophils 0.2% 0-1 PLT 90x 10/L 150-450
Rbc 3.2x 10/L 4-5.4 MPV 12.4 f/L 6.5-12
Hbg 81g/L 120-
160
PDW 16.4 9-17
Hct 0.25 37-47 PCT 0.090
mL/L
.108-
.282

24. 2nd Post-Op Day
CBC typing (8/21/2017)
Parameter Result N Paramete
r
Result N
WBC 19.4x
10/L
4-10 MCV 81.6f/L 80-100
Neutrophils 87.8% 55-65 MCH 27.2 pg 27-34
Lymphocytes
5.2% 25-35 MCHC 333g/L 310-370
Monocytes 5.5% 3-6 RDW-CV 16.4% 11-16
Eosinophils 1.2% 2-4 RDW-SD 48.8 f/L 35-56
Basophils 0.3% 0-1 PLT 117x 10/L 150-450
Rbc 4.7x 10/L 4-5.4 MPV 11.2 f/L 6.5-12
Hbg 129g/L 120-
160
PDW 14.6 9-17
Hct 0.39 37-47 PCT 0.110
mL/L
.108-
.282

25. Final diagnosis
O G3P3(3002) PU term cephalic delivered via LTCS I for
abruptio placenta under GA to a stillborn baby boy BW
2270gms CHVD with superImposed PreEclampsia, IUFD
O Partiall HELLP syndrome
O Anemia secondary to Acute Blood Loss

27. Placenta Abruptio
O Premature separation of a normally implanted placenta
O 1/200 deliveries
O 25% perinatal mortality
O Etiology:
Hemorrhage in the decidua basalis leading to premature
separation and further bleeding.

28. Placenta Abruptio

29. Placenta Abruptio

30. Placenta Abruptio