Placental

Abruption
 Definition

Placental abruption (abruptio placentae) is an

uncommon yet serious complication of pregnancy.
The placenta develops in the uterus during
pregnancy. It attaches to the wall of the uterus and
supplies the baby with nutrients and oxygen.

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 Introduction

• Placental abruption occurs when the placenta partly

or completely separates from the inner wall of the
uterus before delivery.
• This can decrease or block the baby’s supply of
oxygen and nutrients and cause heavy bleeding in
the mother.
• Placental abruption often happens suddenly. Left
untreated, it endangers both the mother and the
baby.

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 Types of Abruptio Placenta

• Depending upon the extent and region of separation

• A complete abruption occurs when the entire
placenta separates.
• A partial abruption exists when part of the
placenta separates from the uterine wall.
• A marginal abruption occurs when the separation
is limited to the edge of the placenta.

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 Types of Abruptio Placenta

• Varieties
• 1, Revealed: Following separation of the placenta, the
blood insinuates downward between the membranes and
the decidua. Ultimately, the blood comes out of the
cervical canal to the visible externally. This is the
commonest type.

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 Types of Abruptio Placenta

• Varieties
• Concealed: The blood collects behind the separated
placenta or collected in between the membranes and
decidua. The collected blood is prevented from coming
out of the cervix by the presenting part presses on the
lower segment.

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 Types of Abruptio Placenta

• Varieties
• Mixed:
• In this type, some part of the blood collects inside (concealed)
and a part is expelled out (revealed)
• Usually one variety predominates over the other. This is quite
commom.

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 Symptoms of Placental abruption
• Placental abruption is most likely to occur in the last
trimester of pregnancy, especially in the last few weeks
before birth.
• Abdominal pain and back pain often begin suddenly.
The amount of vaginal bleeding can vary greatly, and
doesn't necessarily indicate how much of the placenta
has separated from the uterus.
• In some cases, placental abruption develops slowly
(chronic abruption), which can cause light, intermittent
vaginal bleeding.
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Symptoms of Placental abruption

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Symptoms of Placental abruption

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Symptoms of Placental abruption

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Symptoms of Placental abruption

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 Causes of Placental abruption

The cause of placental abruption is often

unknown. Possible causes include trauma or
injury to the abdomen — from an auto accident
or fall, for example — or rapid loss of the fluid
that surrounds and cushions the baby in the
uterus (amniotic fluid).

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 Risk factors for Placental abruption
• The prevalence is more with
– High birth order pregnancies with gravida 5 and
above – three times more common than in first birth.
– Advancing age of the mother
– Poor socio-economic condition
– Malnutrition
– Smoking (vasospasm)

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 Risk factors for Placental abruption
• Hypertension in pregnancy ( pre-eclampsia,
gestational hypertension and essential
hypertension, all are associated with placental
abruption.)
– The mechanism of placental separation in pre eclampsia is:
spasm of the vessels in the utero placental bed (decidua
spiral artery) anoxic endothelial damage
rupture of vessels or extravasation of blood in the decidua
basalis (retroplacental hematoma

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 Risk factors for Placental abruption
• Trauma
– Traumatic separation of the placenta usually leads to its
marginal separation with escape of blood outside
– The trauma may be due to:
• Attempted external cephalic version specially under
anesthesia using great force
• Road traffic accidents or blow on the abdomen
• Needle puncture at amniocentesis

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 Risk factors for Placental abruption
• Sudden uterine decompression
– Sudden decompression of the uterus leads to
diminished are of the uterus adjacent to the
placental attachment and results in separation of the
placenta.
– This may occur following
• Delivery of the first baby of twins
• Sudden escape of amniotic fluid in hydramnios
• Premature rupture of membranes.

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 Risk factors for Placental abruption
• Short cord, either relative or absolute, can bring about placental
separation during labor by mechanical pull.
• Supine hypotension syndrome: in this condition which occurs in
pregnancy there is passive engorgement of the uterine and
placental vessels resulting in rupture and extravasation of the
blood.
• Placental anomaly: circumvallate placenta
• Sick placenta: Poor placentation
• Folic acid deficiency
• Uterine factor: placenta implanted over a septum (Septate uterus
or a sub mucous fibroid.
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 Risk factors for Placental abruption
• Torsion of the uterus leads to increased venous pressure and
rupture of the veins with separation of the placenta.
• Cocaine abuse is associated with increased risk of transient
hypertension, vasospasm and placental aruption.
• Thrombophilias inherited or acquired have been associated with
increased risk of placental infarcts or abruption.
• Prior abruption: risk of recurrence for a woman with previous
abruption varies between 5 to 17%.

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Risk factors for Placental abruption

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 Complications of Placental abruption
For the mother, placental abruption can lead to:

• Shock due to blood loss

• Blood clotting problems
• The need for a blood transfusion
• Failure of the kidneys or other organs resulting from blood
loss
• Rarely, the need for hysterectomy, if uterine bleeding can't
be controlled

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 Complications of Placental abruption
For the baby, placental abruption can lead to:

• Restricted growth from not getting enough nutrients

• Not getting enough oxygen
• Premature birth
• Stillbirth

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 Management of Abruptio Placenta
• Prevention: The prevention aims at
• Elimination of the known factors likely to
produce placental separation.
• Correction of anemia during antenatal
period so that the patient can withstand
blood loss and
• Prompt detection and institution of the
therapy to minimize the grave
complications namely shock, blood
coagulation disorders and renal failure.
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 Prevention of Placental abruption
• Early detection and effective therapy of pre-eclampsia and
other hypertensive disorders of pregnancy.
• Needle puncture during amniocentesis should be under
ultrasound guidance.
• Avoidance of trauma – specially forceful external cephalic
version under anesthesia
• To avoid sudden decompression of the uterus – in acure or
chronic hydramnios, amniocentesis is preferable to
artificial rupture of the membranes.
• To avoid supine hypotension the patient is advised to lie in
the left lateral position in the later months of pregnancy.
• Routine administration of folic acid from early pregnancy –
of doubtful value. 25
 Diagnosis of Placental abruption
• If your health care provider suspects placental
abruption, he or she will do a physical exam to check
for uterine tenderness or rigidity. To help identify
possible sources of vaginal bleeding, your provider
will likely recommend blood and urine tests and
ultrasound.
• During an ultrasound, high-frequency sound waves
create an image of your uterus on a monitor. It's not
always possible to see a placental abruption on an
ultrasound, however.

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 Management
Definitive Treatment (Immediate delivery):
• The patient is in labor: most patients are in labor following a
term pregnancy. The labor is accelerated by low rupture of
the membrane. Rupture of the membranes with escape of
amniotic fluid accelerates labor and it increases the uterine
tone also.
• Oxytocin drip may be started to accelerate labor when
needed.
• Vaginal delivery is favored in cases with:
• Limited placental abruption
• FHR tracing reassuring
• Facilitates for continuous electronic fetal monitoring is
available
• Prospect of vaginal delivery or ●●●
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• Placental abruption with a dead fetus
 Management
Definitive Treatment (Immediate delivery):
• The patient is in labor: most patients are in labor following a
term pregnancy. The labor is accelerated by low rupture of
the membrane. Rupture of the membranes with escape of
amniotic fluid accelerates labor and it increases the uterine
tone also.
• Oxytocin drip may be started to accelerate labor when
needed.
• Vaginal delivery is favored in cases with:
• Limited placental abruption
• FHR tracing reassuring
• Facilitates for continuous electronic fetal monitoring is
available
• Prospect of vaginal delivery or ●●●
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• Placental abruption with a dead fetus
Management

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Complications

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Complications

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Complications

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 Treatment of Placental abruption
The baby is close to full term:
• Generally after 34 weeks of pregnancy, if the
placental abruption seems minimal, a closely
monitored vaginal delivery might be possible. If the
abruption worsens or jeopardizes your or your baby's
health, you'll need an immediate delivery — usually
by C-section.
• For severe bleeding, you might need a blood
transfusion.

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 Conclusion
•Abruptio placenta is life threatening complication of
pregnancy and it is associated with poor maternal and
fetal outcome if not managed appropriately.

•Hence early diagnosis and prompt resuscitative

measures would prevent both perinatal and maternal
mortality and morbidity.

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