Placental abruption (aka abruptio placentae) is a complication of pregnancy, where the placental lining abnormally separates from the uterus, >20 weeks gestation, and prior to birth.
What is placental abruption? It sounds like the placenta is about to blow up ?
Sort of. The word abruption actually means breakaway (like the Kelly Clarkson song ), like if you abruptly leave a group, you're suddenly breaking away. The placenta is a flat organ that attaches bub to the womb's wall to get nutrients. So it's when that suddenly breaks off.
Why does it need to be within that timeframe, after 20 weeks gestation, and before birth?
Because before 20 weeks is previable, so we just call it a miscarriage. It has to be before birth, because after birth, the placenta is SUPPOSED to detach, and in fact come out hopefully, within 30 minutes of delivery .
Asymptomatic, in early stages
Sudden onset abdominal pain, most commonly
Contractions that don't stop, so rapidly that they seem continuous
Pain in the uterus
Uterus may be disproportionately enlarged
Non-reassuring fetal status (i.e. decrased FM, worrisome FHR)
What happens when the organ that attaches bub to mom's womb wall breaks off?
Early on, nothing. There can be sudden onset tummy pain, particularly in the womb area. Vaginal bleeding. Contractions that don't stop. A big uterus. Pale. Signs in bub that make you worry, like less movement, or something strange happening to bub's heart rate.
Grade 0, asymptomatic and only Dx through postpartum examination of the placenta
Grade 1, where the mother may have vaginal bleeding w/ mild uterine tenderness, but there is no disterss of mother/fetus
Grade 2, where the mother is symptomatic but not in shock. Some evidence of fetal distress can be found w/ FHR monitoring
Grade 3, where thre is severe bleeding (which may be occult), leading to maternal shock and fetal death. There may be maternal DIC
Trauma, HTN or coagulopathy, causes forcible detachment of the anchoring placental villi, from the expanding lower uterine segment. This causes bleeding in the uterine lining
This can push the placenta away from the uterus, causing further bleeding
Maternal smoking → 90% increased risk
Maternal trauma, including MVA, assaults, falls
Short umbilical cord
PROM (>24 hours)
Multiparity, multiple pregnancy
Maternal age<20yo, >35yo
Hx of placental abruption in previous pregnancy
Hx of previous C-section
Cocaine intoxication or abuse during pregnancy
Dx by exclusion
CTG → fetal HR is associated w/ severity, can indicate fetal distress
Palpation, of location of fundus → rising fundus can indicate bleeding
U/S → rule out placenta previa, but doesn't Dx abruption
MRI can locate placental abruption
Tx depends on how serious the abruption is, and how far along the woman is in her pregnancy.
Avoid tobacco, alcohol, cocaine during pregnancy
Stay away from activities which have a high risk of physical trauma
Careful monitoring of women who have HTN or previous placental abruption
Maintianing a good diet, icnluding taking folic acid
Regular sleep patterns
Correction of pregnancy-induced HTN
Be aware of Sx of placental abruption (e.g. vaginal bleeding), and get in contact wiht hospital w/o delay if they occur
Blood volume replacement, to maintain BP
Blood plasma replacement, to maintain fibrinogen levels
If <36 weeks gestation, if possible, monitor in hospital
Immediate delivery, if the fetus is mature, or if the fetus/mother is in distress. Vaginal birth is usually preferred over C section unless there is fetal distress. C section is contraindicated in DIC. Pt should be monitored 7 days post-delivery for PPH
Hysterectomy, if there is excessive bleeding from the uterus
Anti-D, if the mother is Rh negative
Effects on mother depends on severity of abruption
Effects on fetus depend on both its severity and gestational age at which it occured
Most common pathological cause of late pregnancy bleeding
Occurs in 0.5% of deliveries
Significant contributor to maternal mortality worldwide
Early and skilled medical intervention is needed to ensure a good outcome, and is not available in many parts of the world
Placental abruption has effects on both mother and fetus
The effects on the mother depend primarily on the severity of the abruption, while the effects on the fetus depend on both its severity and gestational age at which it occurs
The HR of the fetus can be associated with the severity