abruptio

abruptio /ab·rup·tio/ (ab-rup´she-o) [L.] separation.

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abruptio placen´tae  premature detachment of the placenta.

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abruptio [ab-rup´she-o] (L.)

separation.

abruptio placen´tae premature separation of a normally situated but improperly implanted placenta; it usually occurs late in pregnancy, but may take place during labor. Separation of the placenta before the 24th week of pregnancy is considered a spontaneous abortion if the abruption is so severe that the pregnancy is lost.

Contributing factors include multiple pregnancies (grand multiparity), chronic hypertensive disease, direct trauma to the uterus, or sudden release of amniotic fluid.

Premature separation of the placenta is classified from Grade 0 to Grade 3 according to the degree of separation. In Grade 0 mother and fetus are asymptomatic. Diagnosis is made after delivery when the placenta is examined and a clot is found adhering to the maternal surface. Grade 1 is minimal separation that causes some vaginal bleeding and changes in maternal vital signs. Fetal distress and hemorrhagic shock are absent. Grade 2 is moderate separation in which there is evidence of fetal distress and maternal symptoms of a tense uterus and pain on palpation. Grade 3 is the most serious. There is extreme separation which, without prompt intervention, can lead to maternal shock and fetal death.

 Abruptio placentae. A, Mild abruption with concealed hemorrhage. B, Severe abruption with external hemorrhage. C, Complete separation with concealed hemorrhage.

Patient Care. Treatment and patient care are based on the grade of separation and maternal and fetal status. Maternal vital signs are monitored and blood loss is assessed. The uterus is assessed for any tenderness, tension, or rigidity. The location and nature of pain reported by the mother are noted; for example, a sharp stabbing pain high in the fundus can occur when separation begins. Pain that is in addition to the pain of contractions is also significant.

Oxygen may be administered to the mother to limit fetal anoxia. Fetal heart sounds are monitored for signs of fetal distress. The patient is kept in a lateral rather than supine position during labor to prevent pressure on the vena cava and further inhibition of fetal blood supply. Vaginal or pelvic examinations and an enema are restricted lest the placenta be disturbed further.

Grade 2 and Grade 3 separations require delivery as soon as possible, either vaginally or by cesarean section. Without prompt and effective intervention, abruptio placentae can lead to maternal death from hemorrhage, shock, and circulatory collapse. Fetal prognosis depends on the extent of hypoxia suffered by the fetus during labor and delivery.