ABRUPTION PLACENTA-Theprematureseparation of a normally implanted placenta afterthe20thweek of pregnancy, typically with severehemorrhage. Types:a.Centralb.Marginalc.Complete

According to extent of separation:1.Mild:less than 1/6 of placenta is separated bleeding may or may not bepresent (<250 cc), someuterineirritability withno fetal distress, theremay ormay not bevaginal bleeding,vaguebackache2.Moderate:1/6-2/3 separation.Dark vaginal bleeding (<1000mL), with fetal distress, uterinetenderness3.Severe:morethan 2/3 is separated, uterinetenderness,rigidity, dark vaginal bleeding (>1000 mL) however it maybe absentexternally, fetal distress and fetal death, if separatedentirely- maternal shock and f etaldeath,severepain, DICEtiology:1.Thecauseis unknown2.Risk factors may include: a.Uterineanomalies b.Multiparityc.Preeclampsia -Maternal HPNd.Previous caesarian birthe.Renal and vasculardisease f.Trauma to theabdomeng.Previous third trimester bleedingh.Abnormally largeplacentai. Short umbilical cordj. Sudden release of AF3.Behavioral factors:a. cigarette smoking, methamphetamine, cocaine abuseb. maternal alcohol consumption (14 or more drinks per week)Assessment:1.Sharp, stabbing pain high in theuterinefundus 2. Heavy vaginal bleeding if separation begins at placentaledges3.Concealed bleeding if thecenteroftheplacenta separates first4.Uterus firm to board-like, tenseorrigid

5.s/sxof anemia6.s/sxof hypovolemic shockManagement:1.hospitalization2.FHR monitoring3.Maternal V/Smonitoring, I and O monitoring, abdominal circumferenceand fundic height-sudden increasemay indicateinternal bleeding,uterinecontractions secondary toreleaseof prostaglandins by placental separation4.Properpositioning bedrest at side lying position5.IV Fluid administration LR is usually given at 125 cc perhour6.Blood typing and cross matching7.Oxygen administration8.No pelvic, abdominal orvaginalexamination9.Administerprescribed medications:bethametasone, tocolytic therapy (terbutaline) (ritodrine),MgSO4) formild abruption placenta but contraindicated in moderateto severecases forit mayconceal s/s of properdiagnosis andevaluation. 10.Caesarean birth Is preferred11.Vaginal delivery is possible if fetus is already dead, thereis minimal bleeding and motheris stable

LASTING EFFECTS:On the mother:A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery. 'APH weakens for PPH to kill'. The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract. The mother may have problems with blood clotting for a few days. If the mother's blood does not clot (particularly during a caesarean section) and too many transfusions could put the mother into disseminated intravascular coagulation (DIC) due to increased thromboplastin, the doctor may consider a hysterectomy. A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication. In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported.

On the baby: If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery and may die in utero, thus resulting in a stillbirth.The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding. If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth. The newborn may have low blood pressure or a low blood count. If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.The newborn may have learning issues at later development stages, often requiring professional pedagogical aid.Intervention

INTERVENTIONS:Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with or without bleeding. The fundus may be monitored because a rising fundus can indicate bleeding. An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. The mother may be given Rhogam if she is Rh negative.

Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks and neither mother or fetus is in any distress, then they may simply be monitored in hospital until a change in condition or fetal maturity whichever comes first.

Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother is in distress. Blood volume replacement to maintain blood pressure and blood plasma replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Patient should be monitored for 7 days for PPH. Excessive bleeding from uterus may necessitate hysterectomy.