the separation of placenta from decidua and cause hemorrhage

1. ABRUPTIO PLACENTA
JITENDRA SINGH CHOUHAN
PHD Scholar

2. Introduction
Abruptio placentae, also known as placental abruption, is a serious
complication of pregnancy that occurs when the placenta separates
from the uterine wall before the baby is born.
It occurs most commonly around 25 weeks of pregnancy.
Placental abruption occurs in about 1 in 200 pregnancies. Along
with placenta previa and uterine rupture it is one of the most
common causes of vaginal bleeding in the later part of pregnancy.
Placental abruption is the reason for about 15% of infant deaths
around the time of birth

3. Overview
Give a brief overview of what you’ll cover in your presentation.

4. SIGN & SYMTOMS
In the early stages of placental abruption, there may be no symptoms.
When symptoms develop, they tend to develop suddenly.
Common symptoms include
❑ Sudden-onset Abdominal Pain
❑ Contractions That Seem Continuous And Do Not Stop
❑ Vaginal Bleeding
❑ Enlarged Uterus (Disproportionate To The Gestational Age Of The Fetus)
❑ Decreased Fetal Movement
❑ Decreased Fetal Heart Rate.
❑ Disseminated Intravascular Coagulation (DIC)
Vaginal bleeding, if it occurs, may be bright red or dark

5. RISK FACTORS
•Pre-eclampsia
•Chronic hypertension
•Short umbilical cord
•Premature rupture of membranes
•Prolonged rupture of membranes (>24 hours).
•Thrombophilia
•Polyhydramnios
•Multiparity
•Multiple pregnancy
•Maternal age: pregnant women who are younger than 20 or older
than 35 are at greater risk

6. PATHO PHYSIOLOGY
1. the maternal vessels tearing away from the decidua basalis,
not the fetal vessels.
2. A small number of abruptions are caused by trauma that
stretches the uterus. Because the placenta is less elastic than
the uterus, it tears away when the uterine tissue stretches
suddenly
3. Cocaine use during the third trimester has a 10% chance of
causing abruption. Though the exact mechanism is not
known, cocaine and tobacco cause systemic
vasoconstriction, which can severely restrict the placental
blood supply (hypoperfusion and ischemia)
4. placental disease and abnormalities of the spiral arteries
develop throughout the pregnancy and lead to necrosis,
inflammation, vascular problems, and ultimately, abruption

7. Arts and literature
Provide examples of art and literature that are
significant to Women's History Month. Here are
a few examples:
• The writing of Virginia Woolf
• The music of Nina Simone
• The artwork of Frida Kahlo

8. TYPES
1) Partial: The placenta doesn't completely detach from the uterine
wall.
2) Complete: The placenta completely detaches from the uterine wall.
3) Marginal: A minor separation of the placenta that causes vaginal
bleeding.
4) Concealed: Blood is trapped between the placenta and the uterine
wall, so there's no vaginal bleeding. This type of abruption can be
severe enough to cause systemic shock.
5) Revealed: Bleeding tracks down from the site of placental
separation and drains through the cervix, resulting in vaginal
bleeding

9. Conclusion

13. ❖ Physical exam to check for uterine tenderness or rigidity and
inspect the vaginal area for bleeding
❖ A transabdominal ultrasound for confirming the location of
the placenta abruption.
❖ Blood test :- C.B.C , blood type , Rh type
❖ Fetal monitoring :- Monitor fetal heart rate (F.H.R.) and
movement
❖ Other tests :-
➢ Blood pressure
➢ Prothrombin time (PT)/activated partial thromboplastin time
(aPTT)
➢ Fibrinogen study
➢ Blood urea nitrogen (BUN)/creatinine study
➢ Kleihauer-Betke test
➢ Biophysical Profile (BPP)
Examination & Test

14. Initial Management
▪ Begin continuous external fetal monitoring for the fetal heart rate and contractions. The
optimal duration of monitoring after trauma
▪ intravenous access using 2 large-bore intravenous lines.
▪ Institute crystalloid fluid resuscitation for the patient.
▪ Blood Type and crossmatch.
▪ Begin a transfusion if the patient is hemodynamically unstable after fluid resuscitation.
▪ Correct coagulopathy
▪ Administer Rh immune globulin if the patient is Rh-negative.
▪ Begin course of corticosteroids for fetal lung maturity (if the patient is less than 37 weeks
gestation and they have not been previously given during pregnancy).

15. Vaginal Delivery
▪ This is the preferred method of delivery for a fetus that has died secondary to placental
abruption.
▪ The ability of the patient to undergo vaginal delivery depends on her remaining
hemodynamically stable.
▪ Delivery is usually rapid in these patients secondary to increased uterine tone and
contractions.

16. Cesarean Delivery
▪ Cesarean delivery is often necessary for fetal and maternal stabilization.
▪ While cesarean delivery facilitates rapid delivery and direct access to the uterus and its
vasculature, it can be complicated by the patient's coagulation status.
▪ The type of uterine incision is dictated by the gestational age of the fetus, with a vertical or
classic uterine incision often in the preterm patient.
▪ If hemorrhage cannot be controlled after delivery, a cesarean hysterectomy may be required
to save the patient's life.
▪ Before proceeding to hysterectomy, other procedures including correction of coagulopathy,
ligation of the uterine artery, administration of uterotonics (if atony is present), packing of the
uterus, and other techniques to control hemorrhage, may be attempted

17. Resources

18. Thank you