Placental Abruption - Learning Stream

11/2/2020

Placental Abruption

Not all are emergent

1

Definition

?Premature separation of a

normally implanted placenta

before birth

2

1

11/2/2020

Incidence

? Overall incidence

? 1 in 100 births

? Range is

? 1 in 80 to 1 in 250 deliveries

? Accounts for approximately 1/3 of all

antepartum bleeding

? 40 to 60% of abruptions occur prior to 37 weeks

gestation

Francois and Foley, 2017, p. 397

3

Risk Factors

? Increasing parity and/or maternal age

? Maternal substance abuse

? Cigarette smoking

? Dose-response relationship

? Compared with nonsmokers, smokers have a

40% increased risk of fetal death from placental

abruption with each pack of cigarettes smoked

? Smoking and hypertensive disease appear to have

an additive effect on likelihood of abrupton

? Cocaine abuse

? Trauma

? Francois and Foley, 2017, p. 397

4

2

11/2/2020

Risk Factors

? Maternal diseases

? Hypertension

? 5x increased risk for abruption

? Hyperthyroidism

? Asthma

? Francois and Foley, 2017, p. 397

5

Risk Factors

? Preterm premature rupture of membranes

? Rapid uterine decompression associated with

? Multiple gestation

? Polyhydramnios

? Uterine and placental factors

? Anomalies

? Fibroids

? Cesarean scar

? Abnormal placental formation

? Chronic ischemia

? Francois and Foley, 2017, p. 397

6

3

11/2/2020

Risk Factors

? Prior abruption

? After one abruption

? Recurrence risk is 5 to 15%

? Risk increases to 20 to 25% after two abruptions

? Risk of recurrence greater after a severe abruption

? Francois and Foley, 2017, p. 398

7

Risk Factors

? Thrombophilia

? Inconsistent data regarding association

? Hyperhomocysteinemia

? (a fasting homocysteine level greater than 15 ?mol/L)

? May be associated with recurrent abruption

? Francois and Foley, 2017, p. 398

8

4

11/2/2020

Possible Signs & Symptoms

? Pain

? Lower back pain

? Uterine pain or tenderness

? FHR

? Late decelerations, loss of variability, sinusoidal pattern,

tachycardia or bradycardia

? Uterine hypertonus

? Low amplitude, high frequency contractions

? Restlessness

? Occasionally; Nausea and vomiting

? Bleeding¡­...(not always)

? The amount of bleeding may not be proportionate to the

amount of placental separation

9

Some bleed

? Less pain

? Blood usually dark

(venous)

10

5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download