nursing

2. PRESENTATION
0N
ABRUPTION PLACENTA
SUBJECT :OBSTETRICS & GYNECOLOGY
SUBMIITED TO.
MRS. SNEHLATA PARASHAR
M.Sc LECTURER
(OBG & GYN)
SUBMITTED DATE.
SUBMITTED BY.
MISS. RINKU MALI
B.SC NURSING
IV YEAR

3. • INTRODUCTION
•Placental abruption (also referred to as abruptio
placentae) refers to partial or complete placental
detachment prior to delivery of the fetus. The
diagnosis is typically reserved for pregnancies
over 20 weeks of gestation.

5. • DEFINITION
1. It is one form of antepartum hemorrhage where the
bleeding occurs due to premature separation of
normally situated placenta. Out of the various
nomenclature, abruptio placentae seems to be
appropriate one.
2. A serious pregnancy complication in which the
placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta
detaches from the inner wall of the womb of the
delivery.
3. Pre mature separation of a normally situated
placenta after 28 weeks gestation & before birth of
the bady.

7. • TYPES
1. Revealed: Following
separation of the
placenta, the blood
insinuates downwards
between the membranes
and the decidua.
Ultimately, the blood
comes out of the cervical
canal to be visible
externally. This is the
commonest type.
Revealed

8. 2. Concealed : The blood
collects behind the separated
placenta or collected in
between the membranes and
decidua. The collected blood
is prevented from coming out
of the cervix by the
presenting part which presses
on the lower segment. At
time, the blood may percolate
into the amniotic sac after
rupturing the membranes. In
any of the circumstances
blood is not visible outside.
This type is rare. Concealed

9. Mixed ( revealed & concealed )
•3. Mixed : IN this type,
some part of the blood
collects inside (concealed )
and a part is expelled out
(revealed ). Usually one
variety predominant over
the other. This is quite
common.

11. • ETIOLOGY
The causes of abruptio Placentae are unknown, but it is
associated with :
1. High birth order pregnancies with gravida 5 and above
2. Spasm of the uterine vessels
3. Pre-eclampsia
4. High parity ( Grande multiparity )
5. Advancing age of the mother
6. Poor socio-economic condition
7. Malnutrition
8. Smoking ( vaso- spasm)
9. Trauma -
• External cephalic version
• Road traffic accidents
• Needle puncture at amniocentesis

12. • PATHOPHYSIOLOGY

13. • Clinical manifestations
1. Dark red vaginal bleeding
2. Uterine tenderness
3. Abdominal or back pain
4. Fetal distress
5. Shock greater than blood loss
6. Idiopathic premature labour
7. Diminished urinary output
8. Absent fetal heart sound
9. Increase in size of uterus
10.Failure of the uterus

14. • Investigations & Diagnostic findings
1. History taking
2. Physical examination
3. Complete blood cell count
4. Urine analysis
5. Liver function tests
6. Renal function tests
7. Prothrombin time (PTT)
8. Bleeding time (BT)
9. Clotting time (CT)
10.Fibrinogen level
11.Fibrinogen degradation products
12. USG ( Ultrasonography)

15. Normal placenta Placental abruption

16. • Complications
• Maternal complications
1. Hemorrhagic Shock
2. DIC ( disseminated
Intravescular coagulation)
3. Uterine rupture
4. Renal failure
5. Ischemic necrosis of distal
organs (eg. Hepatic, adrenal,
pituitary)
• Fetal complications
1. Hypoxia
2. Anemia
3. Growth retardation
4. CNS anomalies
5. Fetal death

17. • Medical management & treatment
1. Tocolytic agents :
• Magnesium sulfate
• Nifidipin
• Prostaglandin inhibitors :
• Celecoxib
2. Corticosteroids :
• Dexamethasone
• Betamethasone

18. • Surgical management
• Caesarean section: caesarean delivery ( also called a
caesarean section or c – section ) is the surgical delivery
of a baby by an incision through the mother’s abdomen
(belly) and uterus (womb). This procedure is done when
it is determined to be a safer method then a vaginal
delivery for the mother, baby, or both.

20. • Nursing management
• Assess the condition of the patient.
• Vital singn‘s such as blood pressure, pluse, respiration, fetal
heart sounds are monitored frequently & recorded carefully.
• The amount of bleeding is to be assessed & noted down.
• Haematological investigations like blood grouping, cross
matching are to be done immediately & blood should be
arranged & transfused rapidly.
• Urinary out put & colour of skin should be observed &
recorded.

21. • Administer analgesics if she has pain.
• Provide comfortable position ( left lateral Position ) to
prevent vena canal occlusion and compression of
aorta by the gravid uterus.
• Maintain an IV line with 16 gauze intracather to
administer plasma expander & blood.
• Central venous line is inserted to monitor CVP every
2 hourly or more Frequently.
• Provide emotional support by answering her queries.
Relatives should be informed about her Condition and
the prognosis to allay anxiety.

22. • Fundal height and abdominal girth are measured on
hourly basis. Increasing fundal height is indicative of
continuous bleeding behind the placenta.
• Prepartions are done to carry out caesarean section after
her condition stablizes. No matter fetus is alive or dead.
• Administer oxygen to relieve hypoxia.
• Observe her for any complications, eg. Hypotension,
hypovolemia, shock, DIC, renal failure.

23. • Conclusion
• Abruptio Placentae is an important cause of fetal and
maternal morbidity and mortality. The etiology is poorly
understood , various management options are however
available.
• The principle of initial assessment of the patients condition
and subsequent planned management aimed atresuscitation
and prolongation of pregnancy if possible or immediate
delivery either for fetal or maternal indications.