Abruptio Placentae Placental abruption (Also known as abruptio placentae) is a complication of pregnancy, wherein the placental lining has

separated from the uterus of the mother. It is the most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1 of pregnancies world wide with a fetal mortality rate of 20!"0 depending on the degree of separation. #lacental abruption is also a significant contributor to maternal mortality. Common risk factors for placenta abruptio include:

$igh blood pressure (1"0%&0 mm $g or higher), whether it is chronic or has been caused by the pregnancy (pregnancy! induced hypertension or preeclampsia). $igh blood pressure is the most common risk factor linked to placenta abruptio." A past placental abruption. If you ha'e had more than one abruption, your risk is greater.2 Cigarette smoking. (he more you smoke, the greater your risk of abruption. )p to 2* of e'ery 100 placental abruptions are linked to cigarette smoking.*

+ther risk factors for placenta abruptio include cocaine use, ha'ing a surgical scar or uterine fibroid where the placenta has attached, trauma to the uterus, as might occur in a car accident, Abruptions are classified according to severity in the following manner: Grade 0- Asymptomatic and only diagnosed through post partum e.amination of the placenta. Grade 1- (he mother may ha'e 'aginal bleeding with mild uterine tenderness or tetany, but there is no distress of mother or fetus. Grade 2- (he mother is symptomatic but not in shock. (here is some e'idence of fetal distress can be found with fetal heart rate monitoring. Grade - /e'ere bleeding (which may be occult) leads to maternal shock and fetal death. (here may be maternal disseminated intra'ascular coagulation. 0lood may force its way through the uterine wall into the serosa, a condition known as 1ou'elaire uterus.

!igns"!ymptoms contractions that don2t stop pain in the uterus tenderness in the abdomen 'aginal bleeding (sometimes) bach ache #$ams and %ests (ests may include

#el'ic e.am 101, may note decreased hematocrit or hemoglobin and platelets #rothrombin time test #artial thromboplastin time test 3ibrinogen le'el test Abdominal ultrasound

&asting effects 'n the mother:

A large loss of blood or hemorrhage may re4uire blood transfusions and intensi'e care after deli'ery. (he uterus may not contract properly after deli'ery so the mother may need medication to help her uterus contract. 2A#$ weakens, for ##$ to kill2. (he mother may ha'e problems with blood clotting for a few days. If the mother2s blood does not clot (particularly during a caesarean section) and too many transfusions could put the mother into disseminated intra'ascular coagulation (5I1), the doctor may consider a hysterectomy. A se'ere case of shock may affect other organs, such as the li'er, kidney, and pituitary gland. In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though e.treme pain is felt and reported.

'n the baby:

If a large amount of the placenta separates from the uterus, the baby will probably be in distress until deli'ery. It may die inutero, resulting in a /tillbirth.

(he baby may be premature and need to be placed in the newborn intensi'e care unit. $e or she might ha'e problems with breathing and feeding. If the baby is in distress in the uterus, he or she may ha'e a low le'el of o.ygen in the blood after birth. (he newborn may ha'e low blood pressure or a low blood count. If the separation is se'ere enough, the baby could suffer brain damage or die before or shortly after birth.

%reatments for the condition (his condition is usually an emergency and re4uires treatment right away. 6easures will be taken to keep the mother and baby healthy. (his might include !immediate and continuous monitoring of the unborn child !I7 fluids !monitoring of 'ital signs, such as blood pressure, heart rate, and urine output !8watchful management8 if the baby is not in distress, the mother2s 'ital signs are stable, and labor is not in motion. /ome small abruptios will stop bleeding on their own. !'aginal deli'ery if the unborn child and mother are stable !cesarean birth if the mother or baby are unstable !blood transfusion if signs of shock are present

(ursing )esponsibility 6onitor amount of bleeding by weighing all pads and assess the presence and absence of pain. 6onitor maternal 'ital signs and fetal heart rate through continuous e.ternal fetal monitoring. 6onitor uterine contractions. 6easure and record fundal height, which may increase with concealed bleeding.

6onitor hemoglobin and hematocrit for blood lost.

Pathophysiology (rauma, hypertension, or coagulopathy, contributes to the a'ulsion of the anchoring placental 'illi from the e.panding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. (his can push the placenta away from the uterus and cause further bleeding. 0leeding through the 'agina, called o'ert or e.ternal bleeding, occurs 90 of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption. Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death.