Abruption of the Placenta

Dela Pena, Joyce S Subgroup No.3 Members: Alexander, Anneth Musni, Khreystine Kaye

Group 21

Abruption of the Placenta Also termed as:  Abruptio Placentae  In premature separation of the placenta, the placenta appears to have been implanted correctly, however it suddenly begins to separate and bleeding results  Occurs in 10% of pregnancies and is the most frequent cause of perinatal death  Occurs late in pregnancy; may occur as late as during the first or second stage of labor

Risk/Predisposing factors:          Unknown High parity Advanced maternal age Short umbilical cord Chronic hypertensive disease PIH Direct trauma Vasoconstriction (from cocaine or cigarette use) Thromophillitic conditions that lead to thrombosis such as autoimmune antibodies, protein C and factor V Leiden (a common inherited thrombophilia that occurs in 5% of whites and 1% blacks)

Signs and Symptoms:  The bleeding is characterized by heavy painful, dark red bleeding  Sharp, stabbing pain high in the uterine fundus during the initial separation  External bleeding if the placenta separates at the edges first and the blood escapes freely from the cervix  If the placenta separates first at the center, blood may pool under placenta and become hidden  Blood may infiltrate uterine musculature(which is called Couvelaire uterus or Uteroplacental apoplexy) which may form a hard, board-like uterus with no apparent or minimally apparent bleeding present  Uterine becomes tense and rigid to touch  If the bleeding is extensive, a womans reserve of blood fibrinogen may be sed up in her bodys attempt to accomplish effective clot formation and DIC(disseminated intravascular coagulation) syndrome may occur  Shock may occur

Degrees of Separation
 1 -Minimal Separation -Not enough to cause vaginal bleeding and changes in maternal vital signs -No fetal distress or hemorrhagic shock occurs  2 -Moderate separation -Evidence of fetal distress -Uterus is tense and painful on palpation  3 -Extreme separation -Without immediate interventions -Maternal shock and fetal death

Therapeutic Management       Keep woman in lateral position (not supine) luid replacement through intravenous therapy using large gauge needle Oxygen inhalation through mask Monitor fetal heart sounds Record maternal vital signs every 5-15 minutes Do not perform any vaginal or pelvic examination

 Do not give enema  IV administration of fibrinogen or cryoprecipitate (contains fibrinogen) to be used  If vaginal birth is not applicable and seems imminent, Cesarean birth is method of choice(unless DIC has occurred, since it might place a possibility of hemorrhage during or after the surgery from the surgical incision) Source: o Pilliteri, Adele (2010) Maternal & Child Nursing: Care of the Childbearing & the Childbearing Family Edition 6, Volume 1