Placenta abruption is the premature separation of the placenta from the uterine wall, which can lead to serious maternal and fetal complications, most commonly occurring after 20 weeks of gestation. Risk factors include trauma, drug use, maternal age, and conditions like hypertension and smoking. Management is critical and may involve emergency cesarean sections, especially in severe cases with hemorrhage and fetal distress.

1. KESSY JULIUS, P., MD.
Obstetrics & Gynecology Department,
Njombe Regional Referral Hospital.
18th August, 2020.
PLACENTA
ABRUPTION

2. 1. INTRODUCTION
2. Epidemiology
3. Placentalanatomy
4. PATHOPHYSIOLOGY
5. RISKFACTORS
6. CLASSIFICATION
7. SIGNSANDSYMPTOMS
8. COMPLICATIONS
9. DIAGNOSIS
10. MANAGEMENT
OUTLINE

3. Placenta abruption is the premature
separation of all or part of placenta
from the uterine wall resulting in
bleeding (hemorrhage).
Introduction

4. Most common after 20 weeks of
gestation.
Significant cause of perinatal
morbidity and mortality.
Introduction
20 weeks
Third trimester

5. Affects 1% of all pregnancies
worldwide.
epidemiology

6. PLACENTALANATOMY
The embryo
attaches to the
uterine wall.
Placenta forms
from the maternal
and fetal.
Permits gas and
nutrient
exchange.

7. Pathophysiology
Degeneration of arteries cause separation of uterine
wall and decidua basalis

8. RISKFACTORS
1. Blunt trauma (fall, domestic violence, car crush, etc.
2. Drug use e.g. Cocaine and methamphetamine.
3. Multiparity
4. Maternal age (< 20 and > 35 years)
5. Previous abruptions
6. Chronic hypertension with pre-eclampsia
7. Cigarette smoking
8. Chorioamnionitis
9. Oligohydramnios

9. CLASSIFICATION
1. CONCEALED
• Intact placental edges with
hemorrhage within the decidua
basalis beneath the placenta.
• Spotting or limited bleeding.
• Dark red or clotted blood.
• No bleeding.
• Unexplained hypotension or
unexplained anemia.

10. CLASSIFICATION
2. REVEALED
•Placental edges fully removed
from maternal tissue, blood leaks
into the uterine space, and exits
through the vagina.
•Bright red bleeding.
•More bleeding than in concealed.
•The amount of bleeding doesn’t
correlate to severity of
hemorrhage.

11. SIGNS&SYMPTOMS
1. Vaginal bleeding or spotting
2. Abdominal pain or cramping
3. ↑Frequency ↓Amplitude contractions
4. Tender and hard uterus on palpation
5. Abnormalities in FHR
6. Pre-mature labour

12. COMPLICATIONS
MATERNAL
Hypovolemic shock
Sheehan syndrome
Acute Kidney Injury
DIC
FETAL
Intrauterine hypoxia and
asphyxia
Premature birth
IUGR
Fetal death

13. DIAGNOSIS
CLINICALLY IMAGING
Ultrasound – Retro placental
collection of blood

14. MANAGEMENT
Placenta abruption is an emergency
Management depends on the maternal and fetal physiological status
IV fluids to increase circulating volume
Blood products to prevent coagulation
Emergency cesarean section if there is severe hemorrhage and fetal compromise