Abruption Placenta (Accidental Hemorrhage)

Subject: Midwifery I (Theory)

Overview

Abruption placenta is a condition in which the typically located or implanted placenta separates prematurely before the fetus is delivered. It usually happens in the third trimester of pregnancy, but it can happen at any moment after 22 weeks. There are three types of abruption placenta: revealed, concealed, and mixed. The fundamental cause is unknown; however, factors that are frequently associated with placental abruption include maternal hypertension and vascular illness, high parity, poor nutrition, particularly folic acid deficiency, past abortion, preeclampsia, and previous cesarean section, and so on. Preventing, detecting, and treating pre-eclampsia and other pregnant hypertension disorders. After general therapy and investigative measures, do an amniotomy and commence an oxytocin induction.

Abruption placenta is a disorder in which the typically located or implanted placenta separates prematurely before the fetus is delivered. This is yet another type of postpartum hemorrhage. This could be a marginal bleed, which is defined as bleeding from the placental edge or margin. It usually happens in the third trimester of pregnancy, but it can happen at any moment after 22 weeks.

Incidence

It occurs in 1-3 percent of deliveries.
The recurrence rate is approximately 5-17 percent after the first episode and approximately 25 percent after the second.
5% to 1% of pregnancies

Risk Factors

An abrupt reduction in the size of an over-extended uterus, i.e. membrane ruptures linked with polyhydramnios.
Trauma
Chorioamnionitis

Types of Abruption Placenta

Revealed (external):
Following placental separation, blood flows down through the cervix between the membranes and the decidua. Finally, the blood emerges from the cervical canal and is visible from the outside. This is the most prevalent type.
Concealed:
A significant amount of blood gathers behind the divided placenta or between the membranes and decidua. The presenting section, which pressures the lower segment, prevents the gathered blood from exiting the cervix. Outside, no blood is evident in any of the scenarios. It is an uncommon species.
Mixed:
In this section, some blood gathers inside and some are drained out; normally, one kind predominates over the other. This is fairly common.

Etiology

The fundamental cause is unknown; however, the following factors are frequently associated with placental abruption:

Maternal hypertension and vascular disease
High parity
Poor nutrition, especially deficiency of folic acid.
Smoking and drug abuse
Previous abortion
Preeclampsia
Sudden loss in uterine volume
Previous cesarean section
Maternal drug abuse, notably cocaine use and smoking.
Decompression of polyhydramnios
Cute external trauma and version.
Short cord
Tension in the uterus

Clinical features of different types of abruption of the placenta:

Signs and symptoms	Revealed type	Concealed type
Vaginal bleeding	Continuous dark red, rarely severe bleeding	Absent, but present in mixed type
Abdominal pain	No severe pain but discomfort	Acute intense pain in the abdomen
Presenting symptoms of PIH	Headache, edema, and rare vomit	May be present
Shock	Absent	Present
Anemia	Related to visible blood loss	Always present
Uterus feels	Localized tenderness	Tense, tender, hard with rising fundal height
Fetal parts	Easily palpable	Not easily palpable
Vulval inspection	Slightly heavy bleeding	Bleeding absent
Urine output	Normal	Usually diminished
Sonography	Differentiate placenta previa	Assess retroplacental clot
Investigation	Hemoglobin low, proteinuria absent	Hemoglobin is markedly low, and proteinuria is usually present
Fetal heart sound	Usually present	Not usually audible

Diagnosis

Abdominal pain that is intermittent or persistent
Sonography of bleeding after 22 weeks of pregnancy
Examine the retroplacental clot
Distinguish placenta previa

Management

Preventing, detecting, and treating pre-eclampsia and other pregnant hypertension disorders.
The placenta should not be punctured with a needle during amniocentesis.
Trauma avoidance
Avoid abrupt uterine decompression.
Folic acid supplementation on a regular basis
Keep the patient in the left lateral posture to avoid supine hypotension syndrome.

Mild abruption

General therapy and invstigation1 are carried out as directed.
Observe the patient and keep a close eye on her during labor and delivery.
Conservative therapy within the hospital; if the fetus is premature, start an I/V drip with
R/L, N/S, DNS, and make arrangements for blood transfusion.

Moderate Abruption

After general therapy and investigative measures, do an amniotomy and commence an oxytocin induction.
When feasible, vaginal delivery is tried.
If the uterus becomes hypertonic during labor or there are signs of fetal distress, a cesarean section should be performed every once.
Maintain I/V fluid, fluid, and offer a blood transfusion if available.

Severe abruption with a dead fetus

Accept the patient.
Obtain an intravenous line and a blood sample for analysis.
Begin I/V drip and administer necessary I/V fluids.
Catheterize the patient and monitor urine output, which should be kept at 30ml/hr or higher.
As needed, provide oxygen.
To induce and sustain labor, oxytocin may be administered.
Unless there are obstetric reasons, C/S should be avoided as much as possible.

Severe abruption with a life fetus

The general measure described above is used.
After grouping and cross-matching, at least four units of blood must be kept on hand.
If the cervix is not dilated, a symptom of fetal distress, a C/S is required.
Keep I/V fluid, crystalloid, colloids fluid1, and blood on hand as needed.
Every 1-2 hours, take and record vital signs, FHS, and urine output.

Complication

Maternal

Hemorrhage→ reeled and concealed or mixed.
Shock
Blood coagulation disorders,1coagulopath8
Oliguria and anuria due to hypovolemia, utero-renal reflex DIC
Postpartum hemorrhage due to atony of the uterus.
Puerperal sepsis

Fetal

Prematurity
Anoxia due to premature placenta separation.
Fetal death.

Prevention

Early detection and therapy of a woman's illness, like hypertension or diabetes, can lower the risk of placenta abruption.
Avoid using tobacco, alcohol, and other potentially harmful substances.
On-time antenatal and prenatal checkups.
Consumption of folate-fortified prenatal vitamins
To avoid injuries from a fall, utilize a seat belt.
Avoid rapid uterine compression.

References

HealthLine. 2005. 2017 http://www.healthline.com/health/pregnancy/complications-placental-abruption
Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
Mayo Clinic. 1998. 13 December 2014 http://www.mayoclinic.org/diseases-conditions/placental-abruption/basics/definition/con-20024292
Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000901.htm
Medscape. 1994. 2017 http://emedicine.medscape.com/article/252810-overview

Things to remember

It is defined by the premature separation of the typically located or implanted placenta prior to fetal delivery.
This is yet another type of postpartum hemorrhage.
This could be a marginal bleed, which is defined as bleeding from the placental edge or margin. It usually happens in the third trimester of pregnancy, but it can happen at any moment after 22 weeks.
There are three types of abruption placenta: revealed (external), concealed, and mixed.
The fundamental cause is unknown; however, factors frequently associated with placental abruption include maternal hypertension and vascular illness, high parity, poor nutrition, particularly folic acid deficiency, previous abortion, preeclampsia, previous cesarean delivery, and so on.
Preventing, detecting, and treating pre-eclampsia and other pregnant hypertension disorders.
After general therapy and investigative measures, do an amniotomy and commence an oxytocin induction.
If the uterus becomes hypertonic during labor or there are signs of fetal distress, a cesarean section should be performed every once.
Hemorrhage, shock, blood coagulation disorder, oliguria, infection, preterm, and even fetal death can result from placental abruption.

Questions and Answers

What do you understant by Abruption placenta?

Abruption Placenta (Accidental Hemorrhage)

Prior to the delivery of the fetus, the typically positioned or implanted placenta separates prematurely, describing the condition. Another example of anti-partum hemorrhage is this. Marginal bleeding refers to bleeding from the edge or margin of the placenta. It happens during the third trimester of pregnancy, but it can happen at any point after 22 weeks.

What are the Types of abruption placenta?

Placenta Abruption Types

Revealed (External)
- The blood descends through the cervix between the membranes and the decidua after the placenta separates. Finally, the blood exits the cervical canal and is exposed to the outside world. The most typical type is this.
Concealed
- Blood accumulates in significant amounts behind the placenta that has been removed or in the space between the membranes and decidua. The presenting section presses the lower segment to stop the collected blood from exiting the cervix. No matter what the situation, there is no blood outside. It is a rare variety.
Mixed
- One type of blood typically predominates over the other as some of it is expelled out and some of it collects inside this area. This happens frequently.

How can we prevent it?

Prevention

Early diagnosis and timely treatment of conditions affecting women, including as hypertension and diabetes, can lower the risk of placenta abruption.
Steer clear of alcohol, cigarettes, and other hazardous chemicals.
Regular and timely prenatal and antenatal care.
Consumption of folate-containing prenatal vitamins
Preventing injuries from falls by using a seat belt.
Avoid applying sudden pressure to the uterus.

Explain the management of abruption placenta?

Management

The following advice could be useful:

Pre-eclampsia and other pregnancy-related hypertension disorders can be treated effectively through prevention, early identification, and diagnosis.
It is best to prevent puncturing the placenta with a needle during amniocentesis.
Preventing trauma
Avoid abrupt uterine decompression.
Administering folic acid supplements on a regular basis
Maintaining the patient in the left lateral posture will help prevent supine hypotension syndrome.

Mild Abruption

Investigation1 and general treatment are carried out as necessary.
Throughout labor and delivery, keep a close eye on the patient.
In situations where the fetus is preterm, conservative hospital therapy is used.
R/L, N/S, and DNS were inserted into the IV drip as well as plans for a blood transfusion.

Moderate Abruption

After receiving general care and taking investigative action, perform an amniotomy and begin an oxytocin induction.
When possible, vaginal birth is tried.
Deliver the baby right away by caesarean section if the uterus feels hypertonic during labor or if symptoms of fetal distress emerge.
If a blood transfusion is available, keep the I/V fluid and fluid levels up.

Severe Abruption with a Dead Fetus

Embrace the patient
Establish an intravenous line and collect a blood sample for analysis.
Start an IV drip and administer the proper IV fluids.
Catheterize the patient and keep an eye on their urine flow, which needs to be kept at a minimum of 30ml per hour.
As needed, give oxygen.
To start and maintain labor, oxytocin can be administered.
Unless there are obstetric indications, C/S must be emptied as much as feasible.

Severe Abruption with a Life Fetus

The broad action described above is taken.
After grouping and cross-matching, at least four blood units are kept on hand.
If the cervix is not dilated, which is a symptom of fetal distress, C/S must be done.
I/V fluid, crystalloid, colloids fluid1, and blood should be maintained as needed.
As needed, take and record your vital signs, FHS, and urine output every one to two hours.