This presentation is for medical students.

1. ABRUPTION OF
PLACENTA DURING
FIRST STAGE OF
DELIVERY

2. DEFINITION
Placental abruption occurs when the placenta separates from the inner wall of the uterus
before birth. Placental abruption can deprive the baby of oxygen and nutrients and cause
heavy bleeding in the mother.

3. SIGNS AND SYMPTOMS
• Symptoms may include vaginal bleeding, contractions, abdominal tenderness, and decreased fetal
movement. Eliciting any history of trauma, such as assault, abuse, or motor vehicle accident, is
important.
• Frequency of symptoms in placental abruption is as follows:
• Vaginal bleeding
• Abdominal or back pain and uterine tenderness
• Fetal distress
• Abnormal uterine contractions
• Idiopathic premature labor
• Fetal death

4. PHYSICAL EXAMINATION
• The physical examination of a patient who is bleeding must be targeted at
determining the origin of the hemorrhage. Simultaneously, the patient must be
stabilized quickly. With placental abruption, a relatively stable patient may rapidly
progress to a state of hypovolemic shock.
• Do not perform a digital examination on a pregnant patient with vaginal bleeding
without first ascertaining the location of the placenta. Before a pelvic examination
can be safely performed, an ultrasonographic examination should be performed
to exclude placenta previa. If placenta previa is present, a pelvic examination,
either with a speculum or with bimanual examination, may initiate profuse
bleeding.

5. COMPLICATIONS
• Complications from a placental abruption include:
1. For Baby
• Premature birth
• Low birth weight
• Growth problems
• Brain injury from lack of oxygen
• Still birth

6. 2. For Mother:
• Blood loss.
• Blood clotting issues.
• Blood transfusion
• Hemorrhage.
• Kidney failure

7. RISK FACTORS
• Trauma or injury to your uterus (like a car accident, fall or blow to the stomach).
• Previous placental abruption.
• Multiple gestations (twins or triplets)
• Hypertension, gestational diabetes or preeclampsia.
• Smoking or have a history of drug use.
• Short umbilical cord.
• Maternal age 35 or greater.
• Uterine fibroids.
• Thrombophilia (a blood clotting disorder).
• Premature rupture of membranes (the water breaks before the fetus is full term).
• Rapid loss of the amniotic fluid.

8. DIAGNOSIS
• Physical examination
• Blood test
• Perform ultrasound

9. MANAGEMENT
• The placenta can’t be reattached, so treatment options depend on how far along in a
pregnancy, severity of the abruption and status of mother and baby.
• If less than 34 weeks pregnant: Can be admitted into the hospital for monitoring -- as long as baby’s
heart rate is normal and the placental abruption doesn’t seem to be severe. If baby appears to be doing
fine and patient’s stop bleeding, patient eventually might be able to go home. She might also be given
steroids.
• If more than 34 weeks pregnant: might still be able to have a viginal delivery if the abruption doesn’t
seem severe. If it is, and it’s putting mother’shealth or baby’s health at risk then need a C-section right
away. She might also need a blood transfusion.