Placental abruption

1. Abruptio placentae
SUBMITTED BY : PRITISH
BALIYAN
SUBMITTED TO : MRS
GULI MAM
GROUP :414 A

3. List of content
• Definition
• Types
• Causes
• Clinical features
• Diagnosis
• Management

4. Definition
 Placental abruption is the premature separation of the normally implanted
placenta from the uterine wall after the 20th week of gestation until the 2nd
stage of labor.
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6. Abruptio placentae
 Abruptio placentae is also called 'placental
abruption’ .
It is a type of Antipatum hemorrhage .
Definition
It is one of Antipatum hemorrhage where the bleeding
occures due to premature seperation of normally situated
placenta.

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8. Incidence
The incidence of placental abruption’ is 0.42% .It tends
to recur in 8.8% patients.

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10. Classification
 Revealed type: Bleeding is revealed.
 Concealed type: No obvious bleeding.
 Mixed type: Combination of 1&2 above.
 In the concealed type(20%), the hemorrhage is confined within the
uterine cavity, detachment of the placenta may be complete, and
the complications are often severe.
 In the revealed type(80%) the blood drains through the cervix,
placental detachment is more likely to be incomplete, and the
complications are fewer and less severe
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11. Types
 Revealed
 The bleeding that occurs
behind the placenta
trickles down between
uterine wall to be
revealed at vaginal
opening.

12. Placental abruption
 Concealed
 Blood fails to trickles down
and collects between
placenta and uterine wall.
 Mixed
 Part of blood trickle down
and some part of blood
collects behind placenta.

13. Causes
• POOR SOCIOECONOMIC STATUS AND
MALNOURISHED
• ADVANCING AGE OF MOTHER
• SMOKING
• HYPERTENSION
• PREVIOUS HISTORY OF ABRUPTION
• ABDOMINAL TRAUMA
• SUDDEN DECOMPRESSION OF UTERUS

14. Etiology
 Primary cause of P A is uncertain
 Several associated conditions identified:
 Increase in age & parity: 1.3-1.5%
 Chronic hypertension: 1.8-3%
 Preterm ruptured membranes: 2.4-4.9%
 Multifetal gestation: 2.1%
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15. Classification of A P depending on history &
investigations
Grade O : Asymptomatic –incidental finding of retro placental clot
Grade 1 : Vaginal bleeding, no maternal or fetal compromise – uterine tenderness present
Grade 2 : Fetal distress
No evidence of maternal shock
Vaginal bleeding may not be present
Grade 3 : Maternal shock & fetal demise present
Marked uterine tetany & tenderness
Vaginal bleeding may not be present
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16. Cilinical Grading
GRADE -0
CLINICALLY REMAIN ASYMPTOMATIC,DIAGNOSIS IS MADE FOLLOWING DELIVERY
GRADE-1
MILD VAGINAL BLEEDING
UTERUS TENDERNESS MAY OR MAY NOT
PAIN MAY OR MAY NOT
SHOCK ABSENT
FSH GOOD

17. GRADE – 2
• BLEEDING MILD TO MODERATE
• UTERUS TENDER
• PAIN PRESENT
• SHOCK ABSENT
• FETAL DISTRESS

18.  Grade -4
 Moderate to severe vaginal bleeding
 Marked uterus tenderness
 Severe degree pain present
 Shock present
 Fetal heart sound –fetal death

19. Sign and symptoms
 Bleeding is present
 Dark colour bleeding
 Uterus is tensed
 Maternal shock
 Difficulty in palpating fetal parts

20. Signs & symptoms
 Vaginal bleeding: 78%
 Uterine tenderness: 66%
 Back pain: 60%
 Fetal distress: 22%
 Hypertonus: 17%
 Fetal demise: 15%
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21. Management
 Revealed placental abruption
 If bleeding is slight : hospital admission, complete
bed rest , carefull monitoring in immature foetus. A
cesarean section is done once fetus reaches
maturity.
 If bleeding is considerable : a cesarean section is
done .

22.  Concealed placental abruption
 If patient has come in shock , she is promptly
resuscitated with IV fluids, blood transfusion etc. An
emergency cesarean section is done as early as
possible.
 Cesarean histerectomy

23. Pathophysiology
Placental abruption initiated by hge into decidua basalis
Haematoma formation
In concealed type blood accumulates &
seeps into myometrium
Couvelaire’s uterus
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24. Couvelaire’s uterus
 Also called as Utero-placental apoplexy
 First described by Couvelaire in early 1900
 Extravasation of blood into uterine musculature & beneath uterine serosa
 Demonstrated only at laparotomy
 These myometrial hge interfere with uterine contraction to produce PPH
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25. Couvelaire’s uterus
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26. Complications
Maternal:
1. Maternal mortality
2. Hypovolaemic shock
3. Renal failure
4. DIC
5. PPH
6. Rhesus sensitization
7. Complication of massive transfusion
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27. Complications
Fetal:
1. Fetal death
2. Hypoxic brain injury
3. IUGR
4. Neonatal anemia
5. Congenital malformations (CNS)
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28. Diagnosis
 Basis of diagnosis consists of :
 History & physical examinations
 Triad of external bleeding through cervical Os, Uterine or back pain and fetal distress
should be of high suspicion
 Defer digital cervical examinations
 Ultrasound – limited value but for large abruptions hypoechoic areas seen underlying
placenta
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29. Ultrasound
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30. Ultrasound
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32. Laboratory tests
1. Complete blood cell count
2. Blood type & screen
3. Urine analysis,
4. Liver function tests
5. Renal function tests
6. Prothrombin time/ aPTT
7. Fibrinogen levels
8. FDP – Fibrin degradation products
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33. Conclusion
 Abruptio Placentae is an important cause of fetal and maternal
morbidity and mortality. The etiology is poorly understood ,
various management options are however available.
 The principle of initial assessment of the patients condition and
subsequent planned management aimed at resuscitation and
prolongation of pregnancy if possible or immediate delivery either
for fetal or maternal indications.
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