Presentation on placental abruption, with risk factor, complications, treatment and severity

1. Placental Abruption
By
Syed Mohammad Arish Ayub

2. Placenta

4. Placental abruption
 Premature separation of placenta from uterine wall
before delivery of a baby.
 In 0.5 to 1.3% of cases
 Severe abruption can lead to death.

5. Pathophysiology
 Placental abruption occurs when the maternal vessels
tear away from the placenta and bleeding occurs
between the uterine lining and the maternal side of the
placenta.

6. Types
 Partial Placental abruption
 Complete or Total Placental abruption
 Revealed Placental abruptions
 Concealed Placental abruptions

11. Risk factors
 Trauma
 Previous placental abruption.
 Multiple gestations (twins or triplets).
 High blood pressure (hypertension), gestational
diabetes or preeclampsia.
 If you smoke or have a history of drug use.
 Short umbilical cord.

12.  Uterine fibroids.
 Thrombophilia (a blood clotting disorder).
 Premature rupture of membranes (the water
breaks before the fetus is full term).
 Rapid loss of the amniotic fluid.

13. Diagnosis
 Fetal heart monitoring
 CBC (complete blood count)
 Blood and Rh typing
 PT/PTT
 Serum fibrinogen and fibrin-split products
 Pelvic ultrasonography
 Kleihauer-Betke test

14. Classification based on clinical
finding
 Class 0: Asymptomatic
 Discovery of a blood clot on the maternal side of
a delivered placenta
 Diagnosis is made retrospectively
 Class 1: Mild
 No sign of vaginal bleeding or a small amount of
vaginal bleeding.
 Slight uterine tenderness
 No signs of fetal distress

15.  Class 2: Moderate
 moderate amount of vaginal bleeding
 Significant uterine tenderness with tetanic contractions
 Maternal tachycardia.
 Evidence of fetal distress
 Clotting
 Class 3: Severe
 heavy vaginal bleeding
 Tetanic uterus/ board-like consistency on palpation
 Maternal shock
 Clotting
 Fetal death

16. Complications
 Placental abruption can cause life-threatening problems for
both mother and baby.
For the mother, placental abruption can lead to:
 Hypovolemic Shock due to blood loss
 Blood clotting problems
 The need for a blood transfusion
 Failure of the kidneys or other organs resulting from blood loss
 Rarely, the need for hysterectomy, if uterine bleeding can't be
controlled

17. For the baby, placental abruption can lead to:
 Restricted growth from not getting enough nutrients
 Not getting enough oxygen
 Premature birth
 Stillbirth
 Death

18. Treatment
 Monitoring – to ensure both baby and mother are stable.
 Hospitalization – If abruption is moderate to severe
 Medication
 Vaginal delivery
 C section

19. On the basis of severity
Mild abruption
 Observe the patient and monitor carefully the labor and delivery
 IV drip start with ringer lactate, normal saline DNS and make
arrangements for blood transfusion
 Position the patient in left lateral position
Moderate
 Perform amniotomy and initiate an oxytocin induction
 Attempt vaginal delivery first
 If uterus feel hypotonic during labor or sign of fetal distress then c
section
 Maintain iv fluid
 Blood transfusion

20. Severe with dead fetus
 Start IV drip and give IV fluids
 Catheterize the patient and monitor urine output which should
be maintained 30ml/hr
 Oxytocin may be given to induce and sustain labor
 Destructive operation is done to extract the fetus
Severe abruption with live fetus
 At least 4 unit of blood is kept ready
 C section is performed if cervix is not dilated
 Maintain iv fluid, crystalloid, colloids and blood
 Monitor vital sign, FHR and urine output every hour.