abruptio placentae

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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ab·rup·ti·o pla·cen·tae (-brpsh- pl-snt)

n.

The premature detachment of a normally situated placenta.

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abruptio placentae

Etymology: L, ab, away from, rumpere, to rupture

premature separation of the placenta implanted in normal position in a pregnancy of 20 weeks or more or during labor before delivery of the fetus. It occurs in approximately 1 in 200 deliveries, and, because it often results in severe hemorrhage, it is a significant cause of maternal and fetal mortality. Hypertension and preeclampsia are associated with increased rates of occurrence; in many cases, however, there is no explanation. Complete separation (1 in 500 to 700 deliveries) causes immediate death of the fetus. Bleeding from the site of separation causes abdominal pain, uterine tenderness, and tetanic uterine contraction. Bleeding may be concealed within the uterus or may be evident externally, sometimes as sudden massive hemorrhage. In severe cases, shock and death can result in minutes. Cesarean section must be performed immediately and rapidly. Extensive extravasation of blood within the uterine wall may deplete fibrinogen, prolong clotting time, cause intractable bleeding, lead to disseminated intravascular coagulation, and by damaging the uterine musculature, prevent the uterus from contracting well after delivery. Hysterectomy may be necessary to prevent exsanguination. Partial separation may cause little bleeding and may not interfere with fetal oxygenation. If the pregnancy is near term, labor may be permitted or induced by amniotomy. A premature pregnancy may be allowed to continue under close observation of the mother on bed rest. The nurse must be alert to the possibility that bleeding is present but concealed internally and that if all the blood can escape, there may be little pain. Also called ablatio placentae, accidental hemorrhage, placenta abruptio, placental abruption. See also Couvelaire uterus. Compare placenta previa.

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abruptio placentae

Ablatio placentae, abruptio, premature separation of placenta Obstetrics The premature separation of the placenta from its site of implantation in the endometrial before the delivery of the fetus; some degree of AP occurs in 1:85 deliveries; severe AP with total separation of the placenta is an obstetric emergency which occurs about 1 in 500-750 deliveries, and is accompanied by fetal death Clinical Constant abdominal and/or back pain, irritable, tender or hypertonic uterus, vaginal bleeding—seen in most; 30% are asymptomatic Predisposing factors Preeclampsia-eclampsia, chronic HTN, DM, chronic renal disease; mechanical causes are rare–1-5% and include transabdominal trauma, sudden decompression, as occurs in the delivery of a 1^st twin or rupture of membranes in hydramnios, or traction of a short placenta Management Expectant therapy if fetus is immature and bleeding limited, treat shock if present, vaginal delivery if possible, C-section Complications DIC, acute cor pulmonale, renal cortical and tubular necrosis, uterine apoplexy, transfusion hepatitis