Abruptio Placenta E-du

Abruptio Placenta in a nutshell

Discover the symptoms, risks, management, and become educated about this pregnancy complication.
We at Abruptio Placenta E-du are dedicated to providing comprehensive information about abruptio placenta, a serious and potentially life-threatening condition that can occur during pregnancy.

Our goal is to educate and inform individuals, families, and healthcare providers about abruptio placenta, including its causes, symptoms, diagnosis, and treatment options. We understand that this condition can be scary and overwhelming, and we are here to offer support and resources to help you navigate this challenging experience.

What is Placental Abrubtion?

So, what is it?

  • Abruptio Placenta refers to a partial or complete separation of the placenta from the uterine wall. This can cause bleeding in the mother and the fetus’ oxygen and nutritional needs may be affected. It is one of the most common causes of antepartum hemorrhage, which affects the outcomes for both the mother and the fetus.
  • Improving maternal and perinatal outcomes requires prompt intervention and early detection of abruptio placenta in daily clinical practice. A severe case of placental abruption can have serious effects on the mother and her unborn child, including death, if appropriate medical care is not received.
  • In developed nations, abruptio placenta is responsible for approximately 10% of preterm births and 10% to 20% of perinatal deaths. The rate of abruptio placenta has been ascending across a few nations. Around 1% of births in the Philippines result in abruptio placenta.

Cause

  • The majority of the time, there is no known cause, but substance abuse, abdominal trauma, and high blood pressure in the mother are risk factors. Symptoms may include vaginal bleeding, abdominal pain, back pain, uterine tenderness or rigidity, and recurrent uterine contractions.
  • Abruptio placenta’s etiology is still poorly understood, but several clinical and epidemiological studies have found that women with advanced maternal age, multiparity, multiple pregnancies, hypertension, polyhydramnios, if a mother has had this condition before and spontaneous or induced abortion are more likely to develop this kind of condition.
  • Additionally, smoking and drug use by the mother during pregnancy have been linked to an increased risk of placental abruption.

If the mother has placental abruption:

  • Vaginal delivery is still an option if the abruption does not appear to be severe.
  • As soon as the condition reaches the point where it poses a threat to either your own health or the health of your unborn child, you will need a C-section.
    • A blood bonding may be required on the off chance that the unexpectedness makes you lose a ton of blood. The woman's worst-case scenario would be disseminated intravascular coagulation (DIC), necessitating a hysterectomy to prevent exsanguinations.

Etiology

The main cause of Abruptio Placenta is still unknown. However, there are multiple risk factors associated with Abruptio Placenta. Which includes the following:

  • Maternal Hypotension and hypertension
  • Lifestyle of the mother
  • Sudden decompression of the uterus
  • Exposure to physical trauma
  • History of Abruptio Placenta
  • Maternal age over 35
  • Other conditions linked to complications of pregnancy

Abruptio Placenta may occur when vascular structures which support the placenta are compromised. This happens when the vascular network tears away from the maternal site. Vascular networks are responsible for delivering oxygen and nutrients to the fetus. With this being disrupted, it will interfere with the stretching of the uterus. Since, the placenta is not as elastic as the uterus. Thus, when there is a disrupted stretching of the uterus, the placenta remains stable, causing the vascular structures which support the uterine wall to tear away.

About 1% of pregnant women experience placental abruption. Although it can happen at any point after 20 weeks of pregnancy, the third trimester is when it usually happens. When it does, it usually happens unexpectedly. Vaginal bleeding might be present, but it also might not.

Blood volume can change. The placental abruption may be severe even though there isn't a lot of blood present. Blood can occasionally become stuck inside the uterus.

Signs include

  • Pain in your belly or back
  • Tenderness or quick, repeated contractions in your uterus
  • Problems with the baby’s heart rate
  • Placental abruption can happen little by little, too, called “chronic abruption.” You might notice:
    • You have light vaginal bleeding that happens on and off.
    • You have a low amount of amniotic fluid.
    • Your baby isn’t growing as fast as they should.

Symptoms

  • Vaginal bleeding (may or may not be present)
  • Abdominal pain
  • Back pain
  • Uterine tenderness or rigidity
  • Recurrent uterine contractions

Risk factors

  • Previous pregnancy with placental abruption that wasn't brought on by abdominal trauma
  • Chronic high blood pressure
  • Hypertension-related problems during pregnancy, including preeclampsia, HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome or eclampsia
  • A fall or other type of blow to the abdomen
  • Smoking
  • Cocaine use during pregnancy
  • Early rupture of membranes, which causes leaking amniotic fluid before the end of pregnancy
  • Infection inside of the uterus during pregnancy (chorioamnionitis)
  • Advanced maternal age, especially older than 40
  • Carrying more than one baby. Sometimes, delivering the first baby can make the placenta separate before the next baby is ready to be born.
  • Abdominal trauma. This could happen if you fall and hit your belly. It could also happen in a traffic accident if your abdomen is injured, so always remember to buckle up.

Epidemiology

One of the main factors contributing to maternal morbidity and perinatal death is abruptio placenta. Abruptio placenta causes around 10% of preterm births and 10% to 20% of perinatal fatalities in developed countries. The rate of abruptio placenta has been rising across several countries. About 1% of births in the Philippines result in abruptio placenta. The probability of this occurring increases after 20 weeks of pregnancy, however it can occur at any point up to birth. Maternal morbidity and neonatal death are mostly caused by abruptio placenta (Healthy Philippines, 2023). The cause of fetal mortality was severe hypoxia owing to abruptio placenta in 11/42 instances, or 26.2% of cases, according to the University of the East Medical Center in the Philippines.


It is uncertain what causes placental abruption. Its occurrence, however, is connected to a number of risk factors, including maternal high blood pressure, abdominal trauma, and drug abuse. A severe episode of placental abruption, if not treated promptly, can have serious repercussions for the mother and her unborn child, including death.

Nursing Management, Interventions and Considerations

For the Nurse

  • To avoid further damaging the placenta and causing severe bleeding, prevent doing any vaginal or abdominal examinations that would stimulate the uterine activity.
  • Monitor and record the maternal vital signs for baseline data.
  • Monitor and record the maternal vital signs for baseline data.
  • Perform continuous external fetal monitoring and contractions.
  • Assess for any signs of bleeding or hemorrhage.
  • When vaginal delivery is not possible, have a surgical cesarean section prepared as the preferred delivery procedure.
  • Oxygen administration via mask should be performed inorder to lessen fetal distress
  • To restore lost fluids, put an intravenous catheter with a large gauge within a large vein especially when the mother starts to bleed.
  • Check fibrinogen levels via blood sample.
  • Identify the moment the bleeding started, any previous abdominal or uterine injuries, and or pregnancy issues.

For the Patient

  • In the event that an early birth is required, medicine may be given to you to preserve the baby's brain and to aid in the development of the baby's lungs
  • You could be admitted to the hospital for close observation if the abruption looks mild, your baby's heart rate is normal, and if it seems too early for the baby to be born.
  • You can be questioned about when the bleeding began, if you've ever had an abdominal or uterine injury, or whether you've ever had pregnancy-related problems in the past.
  • If you can, ask a friend or loved one to accompany you. In an emergency, having someone nearby can help you recall the information offered.
  • You could require a blood transfusion if there is serious bleeding
  • You might be asked to give a blood sample so that the levels of fibrinogen in your blood can be measured.
  • A tube may be put into a vein in your hand if you begin to bleed in order to replace any lost bodily fluids.
  • You might be sent home if the bleeding stops and if your baby's condition is stable.

Mild placental abruption (less than 34 weeks pregnant)

You will be admitted to the hospital under close observation. Your doctor might administer medication to you in an effort to prolong your pregnancy. If tests reveal that you and your baby seem to be doing well and the bleeding stops, you might be able to return home.


Moderate or severe placental abruption (more than 34 weeks pregnant)

In the event that the abruption does not appear to be severe, vaginal delivery is still a possibility. You will require a C-section as soon as the condition reaches the point where it poses a risk to either your health or your baby’s. A blood transfusion might be required if the abruption causes you to lose a lot of blood.

The worst-case scenario would be for the woman to develop disseminated intravascular coagulation (DIC), and a hysterectomy would be necessary to prevent exsanguinations. This is very uncommon. A hysterectomy, which involves surgically removing the uterus, can stop life-threatening bleeding and other health issues. However, it also means that you won't be able to get pregnant in the future.

Health Education

Remember that:

Placental abruption refers to a partial or complete separation of the placenta from the uterine wall. The mother may hemorrhage as a result, and the baby's oxygen and nutritional needs may be hampered. In most cases, there is no known cause, however risk factors can include substance abuse, abdominal trauma, and high blood pressure in the mother.

A severe episode of placental abruption can have serious effects on the woman and her unborn child, including death, if appropriate medical care is not received. During pregnancy, the placenta develops to supply the fetus with nutrients and oxygen. It also gets rid of trash. Until the baby is born, the placenta typically adheres to the uterine wall. Before giving birth, the placenta can occasionally split from the uterus.

Taking care of yourself during pregnancy to avoid abruptio placenta:

  • Pay attention to changes. Alert your health care team immediately if there's a change in your symptoms or their frequency.
  • Avoid any strenuous exercise. Never lift or run with anything weighing more than 9 kg.
  • Avoid smoking. It can restrict your baby's access to blood. Consult your doctor about medications and stop-smoking programs if you need assistance quitting. These may improve your chances of successfully quitting.
  • Avoid all substances during pregnancy including cigarettes, alcohol, medicines (unless prescribed by your doctor) and recreational drugs.
  • Consult your doctor to find out if you can engage in sexual activity.
  • Nothing should be inserted into your vagina.
  • Keep your phone close by at all times in case you need to call your doctor or nurse advice line as soon as you start bleeding.

In severe cases, complications can include:

  • Lower oxygen levels for the infant, which might cause brain damage.
  • Stillbirth
  • Mothers losing blood and experiencing shock
  • If the bleeding cannot be managed, an immediate hysterectomy (uterus removal through surgery) should be performed.
  • Significant blood loss causes the death of a mother.