1. ABRUPTIO PLACENTAE
B.HEMANATH

2. DEFINITION
 Abruptio Placentae(syn. Accidental
haemorrhage, Premature placental separation):
It is one form of APH where bleeding occurs due to
premature separation of normally situated placenta.

3. TYPES
 Revealed
 Concealed or complete separation
 Mixed
 Marginal separation
 Partial separation
 Pre-placental separation
 Couvelaire uterus

4. TYPES

6. ETIOLOGY
Predisposing factors
• Hypertension in pregnancy
• High Birth order
• Advanced Age of mother
• Smoking
• Poor Socio Economic
Status
• Malnutrition
Other Etiological Factors
• Trauma
• Sudden uterine
decompression
• Short Cord
• Supine Hypotension
syndrome
• Placental Anomaly
• Folic Acid deficiency
• Placenta implanted over
septate uterus
• Torsion of uterus
• Cocaine abuse
• Thrombophilias
• Prior abruption

7. PATHOGENESIS
Etiological factors
Haemorrhage into decidua basalis and hematoma formation
Degeneration and necrosis of decidua basalis with adjacent placenta
Rupture of basal plate forming communication b/w hematoma and
intervillous space
Fluid and blood percolate into myometrium upto serous coat(couvelaire
uterus)
Sometimes serosa split open and blood enters into peritoneal
cavity

8. PATHOLOGY
 Usually retro placental hematoma not evident
 It is evident only after expulsion by features like
 depression on maternal surface with clot
 areas of infarction
 Couvelaire uterus
 Dark port wine colour
 Sub peritoneal petechial haemorrhages
 Free blood in peritoneum sometimes
 Other Organs
 Liver – fibrin knots in sinusoids
 Kidneys – ATN and ACN
 Shock proteinuria

9. CLINICAL GRADING
Grade 0
• No Clinical
Features.
Diagnosis
made after
placental
inspection
following
delivery
Grade 1
• Vaginal
bleeding
slight
• Uterus
minimal
tenderness
• Maternal BP
and
fibrinogen
levels
normal
• FHS good
Grade 2
• Vaginal
bleeding mild
to moderate
• Uterus
tenderness
present
• Maternal pulse
increased and
fibrinogen
levels
decreased
• Foetal distress
or death
Grade 3
• Vaginal
bleeding
severe
• Uterus
tenderness
marked
• Shock occurs
• Foetal death is
a rule
associated
with anuria
coagulation
defect

10. CLINICAL FEATURES:
Revealed
Mixed
(Concealed predominate)
Symptoms
Abd. Discomfort followed by vaginal
bleeding
Acute abdominal intense pain
followed by slight vaginal bleeding
Character of
bleeding
Dark colour continuous Blood stained serous discharge
continuous
General
condition
Proportionate to visible blood loss Disproportionate shock usually
present
Uterine ht.
Proportionate to GA Disproportionately enlarged
Uterus feel
Normal with local tenderness Tense, tender and rigid
Fetal parts Easily identified Difficult
FHS Present Absent
UO
Normal diminished

11. CLINICAL FEATURES: LABORATORY
Revealed
Mixed
(Concealed predominate)
HB%
Low proportionate to blood loss Markedly lower disproportionate to
blood loss
Coagulation
Profile
Unchanged Variable changes
Urine for protein
May be absent Usually present

12. ULTRASONOGRAPHY
 To rule out placenta praevia but not diagnostic
 Early haemorrhage is hyperechoic or isoechoic
 Negative findings do not exclude placental
abruption

14. DIFFERENTIAL DIAGNOSIS
 Revealed
 With placenta praevia
 With indeterminate bleeding
 Mixed or Concealed
 With rupture uterus
 With rectus hematoma
 With appendicular perforation
 With volvulus

15. PROGNOSIS
 Depends on
 Clinical types
 Degree of placental separation
 Interval b/w placental separation and baby delivery and
efficacy of treatment
 Bleeding is almost always maternal

16. o Prevention
• Elimination of known factors
• Correction of anaemia
• Prompt detection and institution of therapy to avoid complications
o Treatment
• At home:-treated as said in placenta praevia and shifted
immediately to well equipped hosp.
• At hosp :-
 Assessment of case
 Emergency measures
 Management options
a) Definitive
b) Management of complications
c) Expectant management
MANAGEMENT

18. THANK YOU