Placental abruption occurs when the placenta separates from the uterus prematurely before birth. It can range from mild to severe, with symptoms including vaginal bleeding, abdominal pain, and distress in both mother and fetus. Risk factors include hypertension, smoking, and previous uterine trauma. Diagnosis involves clinical exams and imaging tests. Management depends on severity but may include close monitoring, blood transfusions, medications to induce labor, or cesarean delivery if the mother or fetus is in danger. While maternal mortality has decreased, fetal prognosis is worse, with over 10% of affected fetuses dying.

1. Placental Abruption
Prepared by
Ms. Jenisha Adhikari
BSN

2. Definition
Placenta - The placenta is an organ that connects
the developing fetus to the uterine wall to
allow nutrient uptake, thermo-regulation,
waste elimination, and gas exchange via the
mother's blood supply; to fight against internal
infection; and to produce hormones which
support pregnancy

3. Abruption - the sudden breaking away of a
portion from a mass.

4. Introduction
• Placental abruption is premature
separation of placenta from the uterus/ in
other words separates before childbirth.
• It occurs most commonly around 25 weeks
of pregnancy characterized by vaginal
bleeding, lower abdominal pain,
and dangerously low blood pressure

5. Incidence
It is seen 1-3% of deliveries and accounts
for 2 out of 3 cases of ante partum hemorrhage
Recurrent rate is about 5-17% after the first
episode and about 25% after the second

6. Etiology
• Maternal hypertension
• Mulitparity
• Poor nutrition ; folic acid deficency
• Decompression of polyhydramnious
• Short cord
• Tension of uterus

7. • Blunt trauma
– accidents
– Fall
– Domestic voilence
• Drugs
– Cocaine
– Methampathamine

8. Type
• Revealed
• Conceled
• Mixed

9. 1. Revealed the blood comes downward
between the membrane and decidua. It occurs
at the margin
2. Concealed the blood is collected in between
the membrane and decidua, it occurs at the
center
3. Mixed in this type, some part of the blood
collect inside (concealed and part is expelled
out (revealed )

11. Risk factors
• . History of placental abruption or previous
Caesarian section
• Pre-eclampsia
• uterine anatomy (e.g. bicornuate uterus)
• Short umbilical cord

12. • Prolonged rupture of membranes (>24 hours)
• Multiple pregnancy
• cocaine and tobacco abuse
• Maternal age: pregnant women who are
younger than 20 or older than 35 are at greater
risk

13. Classification of Placental Abruption
• Clinical classification is as follows:
• Class 0 - Asymptomatic
• Class 1 - Mild (represents approximately 48%
of all cases)
• Class 2 - Moderate (represents approximately
27% of all cases)
• Class 3 - Severe (represents approximately
24% of all cases)

14. • Class 1 characteristics include the following:
• No vaginal bleeding to mild vaginal bleeding
• Slightly tender uterus
• Normal maternal BP and heart rate
• No coagulopathy
• No fetal distress

15. Class 2 characteristics include the following:
• No vaginal bleeding to moderate vaginal
bleeding
• Moderate to severe uterine tenderness with
possible tetanic contractions
• Maternal tachycardia with orthostatic changes in
BP and heart rate
• Fetal distress
• Hypofibrinogenemia (ie, 50-250 mg/dL)

16. • Class 3 characteristics include the following:
• No vaginal bleeding to heavy vaginal bleeding
• Very painful tetanic uterus
• Maternal shock
• Hypofibrinogenemia (ie, < 150 mg/dL)
• Coagulopathy
• Fetal death

17. Sign and symptoms
It depends on
– Degree of separation of placenta
– Speed at which separation occurs
– Amount of blood concealed inside the uterine
cavity

18. Sign and symptom
Sign and symptoms Revealed Concealed
Vaginal bleeding Usually slight, continious,
dark red, rarely sever
bleeding
Absent, but present in case of
mixed
Abdominal pain No sever pain but discomfort Acute agonizing pain present
shock absent Present ( moderate to severe
)
anemia Usually absent Always present
Per sbdomen uterus Localized uterine tenderness,
fetal presentation are usual
FHS is present
Tender, tensed, hard with
rising fundal height, FHS is
not audible, fetal part is not
palpable
Urinary output normal Usually diminished
Vulval inspection Slight to heavy bleeding Bleeding is absent

19. Diagnosis
• Laboratory test
– CBC
– PT
– BUN/ Creatinine
• Fibrinogen level
• Imaging
– Transvaginsal ultrasonogram
– Transabdomen ultrasonogram

20. Ultrasound showing placenta abruption

21. Complication
Maternal
– shock
– blood coagulation disorder, coagulopathy
– Oliguria or anuria
– Postpartum hemorrhage due to atont of uterus
– Puerperal sepsis
Fetal
– Prematurity
– Anoxia
– Fetal death

22. Prognosis
• Nowadays maternal deaths due to placental abruption are
rare.
• The fetal prognosis is worse than the maternal prognosis;
– approximately 12% of fetuses affected by placental abruption
die.
– 77% of fetuses that die from placental abruption die before
birth;
– the remainder die due to complications of preterm birth
• Outcomes for the baby also depend on the gestational age.

23. Management
• Immediate delivery of the fetus may be
indicated if the fetus is mature or if the fetus or
mother is in distress.
• Blood volume replacement to maintain blood
pressure and blood plasma replacement to
maintain fibrinogen levels may be needed.

24. • Vaginal birth is usually preferred
over Caesarean section unless there is fetal
distress. Caesarean section is contraindicated
in cases of disseminated intravascular
coagulation.
• Excessive bleeding from uterus may
necessitate hysterectomy.

25. On the basis of severity
Mild abruption
– General treatment and investigation are performed
– Observe the patient and monitor carefully labor
and delivery
– IV drip start with Ringer lactate, Normal saline
DNS and make arrangement for blood transfusion
– Position the patient in left lateral position

26. Moderate abruption
– Perform amniotomy and initiate an oxytocin
induction after taking general treatment and
investigation
– Vaginal delivery is attempted first
– If the uterus feels hypertonic during labor or sign
of fetal distress appear, delivery immediately by
caesarean section
– Maintain IV fluid
– Blood transfusion is given

27. Severe abruption with dead fetus
– Secure intravenous access and obtain sample for
investigation
– Start IV drip, give appropriate IV fluids
– Catheterize the patient and monitor urine output
which should be maintained 30 ml/hr
– Oxytocin maybe given to induce and sustain
labour
– Destructive operation is done to extract fetus
otherwise

28. Severe abruption with live fetus
– General measure as previous
– Atleast 4 unit of blood is kept ready after grouping
and cross matching
– CS must be performed if cervix is not dialated and
sign of fetal distress is seen
– Maintain IV fluid, crystalloid, colloids and blood
as necessary
– Monitor vital sign, FHS and urine output every 1-2
hourly as needed

30. Prevention
• Avoiding tobacco, alcohol and cocaine during
pregnancy decreases the risk.
• Staying away from activities which have a
high risk of physical trauma is also important.
• Women who have high blood pressure or who
have had a previous placental abruption and
want to conceive must be closely supervised
by a doctor.

31. • Maintaining a good diet including taking foliated,
regular sleep patterns and correction
of pregnancy-induced hypertension.
• It is crucial for women to be made aware of the
signs of placental abruption, such as vaginal
bleeding, and that if they experience such
symptoms they must get into contact with their
health care provider/the hospital without any
delay.