Abruptio Placenta

What is it?
Placenta abruptio is the separation of the placenta from its attachment to the uterus wall before the baby is delivered. The incidence is approximately 1 in 100 births!

What causes it?

The causes are still not completely known, however the risk factor are: Alcohol & cocaine, cigarette smoking trauma (fall, hit to the abdomen, automobile accident) sudden intrauterine pressure changes (amniotomy) previous abruptio chronic hypertension women older than 35 higher in Caucasians and African Americans pregnant with twins or triplets

Three Types:
Marginal: The placenta separates at its edges, the blood passes between the fetal membranes and the uterine wall, and the blood escapes vaginally Central: The placenta separates centrally, the blood is trapped between the placenta and the uterine wall, this results in concealed bleeding because it is sealed within the two. Complete: There is total separation of the placenta, there is massive vaginal bleeding

Signs and symptoms:

Pain-abdominal and back (sharp, frequent uterine contractions with no relaxation) Uterine tenderness Bleeding vaginally Couvert If in centre of placenta (uterus becomes hard and board like) Shock DIC

Tests may include:

Abdominal ultrasound Complete blood count Fetal monitoring Fibrinogen level Pelvic exam Vaginal ultrasound

Treatment and Nursing care:

Treatment may include giving fluids intravenously and blood transfusions, for fluid replacements. The mother will be administered oxygen by mask. The woman will also be placed on her left side to prevent pressure on her vena cava. And to reduce the risk of DIC, they will type and cross-match for blood transfusions, and check the mothers fibrinogen levels. The mother will be carefully monitored for symptoms of shock. The unborn baby will be watched for signs of distress, which includes an abnormal heart rate. An emergency cesarean section may be needed. If the baby is very premature and there is only a small placental separation, the mother may be kept in the hospital for close observation. She may be released after several days if the condition does not get worse.