The document discusses placental abruption, which is the separation of the placenta from the uterus prior to delivery. It defines placental abruption and notes that 15% occur during labor and 30% are only identified after delivery. Placental abruption is classified into three grades based on symptoms, from slight vaginal bleeding to severe bleeding. Treatment involves managing hemorrhage, shock, and coagulopathy, as well as assessing the need for early delivery of the fetus depending on the condition of the mother and baby.

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2. GENERAL CONSIDERATION
Definition
The separation of the placenta from
its site of implantation after 20 weeks
of gestation or during the course of
delivery.
15% occur during labor, and 30% are
identified only by inspection of the
placenta after delivery.
Frequency
1% per pregnant s .
Incidence of fetal death
200‰-350‰

3. ETIOLOGY AND CLASSIFICATIONS
At the initial point of placental separation, non
clotted blood courses from the site of injury.
The enlarging collection of blood may cause
further separation of the placenta. Bleeding
can be either concealed or revealed
(apparent). A concealed hemorrhage occurs
in 20% of cases and describes an abruption
in which the bleeding is confined within the
uterine cavity. The most common abruption
is associated with a revealed or external
hemorrhage, where the blood dissects
downward toward the cervix . Placental
abruption may be broadly classified into
three grades that correlate with clinical and
laboratory findings .

4. Classifications of Placenta Abruption
Grade 1: Slight vaginal bleeding and some uterine
irritability are usually present.
Grade 2: External uterine bleeding is absent to
moderate. The uterus is irritable and tetanic or very
frequent contractions may be present.
Grade 3: Bleeding is moderate to severe but may be
concealed. The uterus is tetanic and painful. Maternal
hypotension is frequently present and fetal death has
occurred.

5. ETIOLOGY
Uncertain (primary cause)
Risk factors
1. Increased age and parity
2. Vascular diseases: preeclampsia,
chronic hypertension, renal disease.
3. Mechanical factors: trauma,
intercourse, polyhydramnios,
4. Supine hypotensive syndrome
5. Smoking, cocaine use, uterine
myoma(masses)
6. Are pregnant with twins or triplets
7. Have had a previous placental
abruption

6. PATHOLOGY
Main change
hemorrhage into the decidua basalis
→ decidua splits → decidural
hematoma → separation, compression,
destruction of the placenta adjacent to
it
Types
revealed abruption, concealed
abruption, mixed type

9. PATHOLOGY

12. MANIFESTATION
Vaginal bleeding companied with abdominal
pain
Mild type
abruption ≤ 1/3, apparent vaginal
bleeding
Severe type
abruption > 1/3, large retroplacental
hematoma, vaginal bleeding companied
by persistent abdominal pain, tenderness
on the uterus, change of fetal heart rate.
shock and renal failure.

13. ADJUNCTIVE EXAMINATION
Ultrasonography
1. Position of placenta, severity of
abruption, survival of fetus
2. Signs: retro placental hematoma
3. Negative findings do not exclude
placental abruption
Laboratory examination
1. consumptive coagulopathy: DIC
2. Function of liver and kidney.

15. DIAGNOSIS
sign and symptom
1. Vaginal bleeding
2. Uterine tenderness or back pain
3. Fetal distress
4. High frequency contractions
5. Hyper tonus ~
the elastic tension of living muscles
6. Idiopathic preterm labor
7. Dead fetus
Vaginal bleeding in the third trimester of
pregnancy is the hallmark of placental
abruption or placenta previa

16. DIAGNOSIS
Ultrasonography
Differential diagnosis
1. Placenta previa
Painless bleeding
2. Pre-rupture of uterus
dystocia

17. COMPLICATION
DIC
Hypovolemic shock
Amnionic fluid embolism
Acute renal failure

18. DIC
- An acquired
syndrome
characterized by
the intravascular
activation of
coagulation with
loss of localization
arising from
different causes. It
can originate from
and cause damage
to the
microvasculature,
which if sufficiently
severe, can produce
organ dysfunction.

19. TREATMENT
1- Treatment will vary depending upon
gestational age and the status of
mother and fetus
2- Treatment of hypovolemic shock:
intensive transfusion with blood
3- Assessment of fetus
4- Termination of pregnancy: CS or
Vaginal delivery

20. TREATMENT
Treatment of consumptive coagulopathy
1. Supplement of coagulation factors:
fresh blood, frozen blood plasma,
fibrinogen, blood platelet.
2. Heparin: high coagulation
3. Anti-fibrinolysis
Prevention of renal failure

21. MANAGEMENT:
The potential for rapid deterioration
(hemorrhage, disseminated intravascular
coagulation [DIC], fetal hypoxia)
necessitates delivery in some cases of
placental abruption. However, most
abruptions are small and non-
catastrophic, and therefore do not
necessitate immediate delivery. Certain
actions, including hospitalization,
laboratory studies, continuous
monitoring, and ongoing patient support
should be initiated when placental
abruption is suspected

22. CARE FOR THE PATIENT WITH
ABRUPTION PLACENTAE
* Hospitalization
• Intravenous placement with a large-bore catheter (16-gauge)
• Lab work: Includes CBC, coagulation studies (fibrinogen, PT,
PTT, platelet count, fibrin degradation products), type and screen
for 4 units of blood Betamethasone may be given to the woman
to promote fetal lung maturity when delivery is not imminent.
• Rh(D)-negative patients should receive RhoGAM to prevent
isoimmunization.
• Continuous evaluation of intake and output
• Continuous electronic fetal monitoring
• Delivery (cesarean or vaginal birth) may be initiated depending
on the status of the mother and the fetus.
• Nursing care is centered on continuous maternal–fetal
assessment, with on-going information and emotional support for
the patient and her family.

23. Video

24. REVIEW:
Q1- When does the separation of the placenta
happen?
Q2- what is the hallmark of placenta
abruption?
Q3- what are the types of placenta abruption?
Q4- what is the 3 types of placenta abruption?
Q5- how to care for a patient of placenta
abruption?

25. THE
END
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