Abruptio placenta

Is the separation of the placenta from the site of uterine implantation that occurs before the delivery of the fetus .

Causes include abnormally short umbilical cord, abdominal trauma, and sudden loss of uterine volume.

Occurs when all or part of the placenta is pushed off the endometrial wall by maternal arterial blood.

Leads to the sudden loss of placental perfusion and fetal oxygenation, leading to fetal death and maternal hemorrhage.

Risk factors include smoking, advanced age, diabetes, hypertension, drug abuse, alcoholism, history of prior abruptio placenta, increased uterine distention and a number of prior deliveries.

Most cases are idiopathic.

A severe occurrence occurs in one in 500 to 750 deliveries, resulting in fetal death and this degree of placental separation prior to delivery may occur in one out of 150 deliveries.

                                                                                                                                                                                                                                              Occurs in about 1%Patients may present with abdominal pain, back pain, or vaginal bleeding. 

Patients may present with sudden exacerbation of abdominal pain during labor, heavy vaginal bleeding followed by shock.

May result in premature birth, low birth weight infants, severe blood loss from the mother, fetal and maternal death.

Usually occurs in the third trimester, but can occur any time after the 20th week of pregnancy.

Hypertension is the most common risk factor linked to the process.

The presence of a uterine fibroids or previous uterine scar are risk factors.

May be a result of premature rupture of membranes, especially the infection of the uterus is present.

Patients may present with a sore uterus that may feel hard, signs of early labor and

symptoms of shock.

Diagnosis rests on a medical history, physical examination, and the process of elimination.

Fetal heart monitoring is done to assess the fetus’s condition.

An ultra-sound examination can detect about 50% of placental abruptions.

The patient’s hematological and coagulation processes, must be evaluated immediately.

Pathophysiology is a result of bleeding into the decidua -basalis which separates the placenta and creates hematoma formation for separating the uterus and the placenta.

The separation of the placenta from the uterine wall compresses placental structures and compromises the blood supply to the fetus.

blood may penetrate through the uterine wall into the peritoneal cavity resulting in Couvelaire uterus.

With increased uterine pressure the uterus may rupture and lead to a life-threatening obstetrical emergency.

Severity of feel distress correlates with the amount of placental separation and immediate cesarean delivery is indicated in near complete or complete abruption.

Fetal mortality occurs in approximately 15% of cases.

80% of patients have vaginal bleeding, 70% percent with the abdominal or back pain and uterine tenderness, 60% have fetal distress, 35% percent with abnormal contractions, 25% have idiopathic premature labor.

Classification is based on the extent of separation that is, partial or complete, and by location marginal vs. central.

Class 0: asymptomatic and diagnosed retrospectively when examining the delivered placenta.

Class I: mild separation and occurs in approximately 48% of cases and is associated with minimal to no vaginal bleeding, slightly tender uterus, normal blood pressure, no coagulopathy and no fetal distress.

Class II: refers to a moderate separation accounts were 27% of all cases and findings may range from no vaginal bleeding to moderate bleeding, moderate to severe uterine tenderness, possible contractions, maternal tachycardia with orthostatic blood pressure changes, and heart rate changes, fetal distress and fibrinogen between 50 and 250 mg per deciliter.

Class III: no vaginal bleeding to heavy vaginal bleeding, painful uterine contractions, maternal shock, hypofibrinogenemia with fibrinogen levels less than 150 mg per deciliter, coagulopathy and fetal death.

Maternal trauma accounts for 1.52 9.4% of cases.

May be responsible for about 6% of maternal deaths.

Despite prematurity delivery is required in severe cases or when maternal or fetal distress occurs.

Cesarean delivery is often required if fetal compromise is present.

Cesarean delivery may be complicated by further hemorrhage, infection, and need for blood transfusion, need for blood products, and in rare cases, death.

DIC may occur from this process.

More common in African American women.

More common in women younger than 20 and older than 35 years of age.

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