Placental abruption occurs when the placenta prematurely separates from the uterine wall before birth. It affects 0.5-1.3% of pregnancies and can be partial or complete. Risk factors include trauma, high blood pressure, smoking, and premature rupture of membranes. Symptoms range from mild vaginal bleeding to heavy bleeding and fetal distress. Both mother and baby can experience life-threatening complications like blood loss, restricted fetal growth, and stillbirth. Treatment depends on the severity but may include monitoring, hospitalization, medications, and vaginal delivery or c-section.

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.