Abruptio Placenta FPPT.

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Gracy Espino
 Abruptio Placenta
• Also called placental abruption
• a premature separation of a
normally implanted placenta
from the uterus, usually after 20
weeks gestation.
 Detachment of the
Placenta before the
birth of the baby
Placenta’s role:
• Maintaining
pregnancy
• Delivers oxygen &
nutrients
• Removes waste

When should the placenta

detach?
After the birth of the baby
Types:

• Complete placental
abruption: The placenta
is completely separated
from the lining of the
uterus, causing heavy
vaginal bleeding.
Types:
• Marginal (partial)
placental
abruption: The
placenta is separated
only at the edges,
resulting in some
vaginal bleeding
Types:
• Concealed (central or
silent) placental
abruption: The blood is
trapped between the
placenta and the uterine
wall with no vaginal
bleeding.
What causes placental abruption?
• The causes of
placental abruption
are not completely
known.
Risk Factors:
• Multiparity
• Short umbilical cord.
• Advanced maternal age
• Direct trauma
• Chorioamnionitis
• Maternal HPN
• Pre-eclampsia
Risk Factors:
• History of abruptio
• PROM
• Multiple pregnancy
• Maternal use of cocaine
• Maternal cigarette smoking
Signs and symptoms: DETACHED
D - Dark red bleeding
E - Extended Fundal Height
T - Tender Uterus
A - Abdominal pain / contraction
C - Concealed bleeding
H - hard abdomen; Most often called as
Couvelaire uterus (Tense & rigid)
E - Experience DIC (Dessiminated
Intravascular coagulation)
D – Distressed baby
Types:
• Grade 0. No indication of
placental separation and
diagnosis of slight separation is
made after birth.
• Grade 1. There is minimal
separation which causes vaginal
bleeding, but no changes in fetal
vital signs occur.
 Types:

• Grade 2. Moderate separation

occurs and fetal distress is already
evident. The uterus is also hard
and painful upon palpation.
• Grade 3. Extreme separation;
maternal shock and fetal death is
imminent if no interventions are
done.
Diagnostic Tests:
• Hemoglobin level and
fibrinogen level.
• These tests are performed to rule
out disseminated intravascular
coagulation.
• Ultrasound
 Nursing Assessment:
• Assess for signs of shock,
especially when heavy bleeding
occurs.
• Assess if the bleeding is external
or internal. pad count
• Monitor contractions if separation
occurs during labor.
 Nursing Assessment:
• Assess for the quality of pain.
• Place the woman in a lateral,
not supine position to avoid
pressure in the vena cava.
• Monitor fetal heart sounds.
Nursing Interventions
• Monitor maternal vital signs to
establish baseline data.
• Avoid performing any vaginal
or abdominal examinations to
prevent further injury to the
placenta.
 Medical Management
• Intravenous therapy. Once the woman
starts to bleed, the physician would
order a large gauge catheter to
replace the fluid losses.
• Oxygen inhalation. Delivered via face
mask, this would prevent fetal anoxia.
• Fibrinogen determination. This test
would be taken several times before
birth to detect DIC.
Medical Management
• Complete Bed rest
• Administration of tocolytics
to reduce uterine activity
• Steroids to accelerate fetal
lung maturity
 Surgical Management
• Cesarean delivery
• Hysterectomy