Nursing Central: Abruptio Placentae

Abruptio Placentae

INTRODUCTION

DRG Category: 774

Mean LOS: 3.3 days

Description MEDICAL: Vaginal Delivery with Complicating Diagnoses

classification section:

Abruptio placentae is the premature separation of a normally implanted placenta before the delivery of the baby. It is characterized by a triad of symptoms: vaginal bleeding, uterine hypertonus, and fetal distress. It can occur during the prenatal or intrapartum period. In a marginal abruption, separation begins at the periphery and bleeding accumulates between the membranes and the uterus and eventually passes through the cervix, becoming an external hemorrhage. In a central abruption, the separation occurs in the middle, and bleeding is trapped between the detached placenta and the uterus, concealing the hemorrhage. Frank vaginal bleeding also does not occur if the fetal head is tightly engaged. Since bleeding can be concealed, note that the apparent bleeding does not always indicate actual blood loss. If the placenta completely detaches, massive vaginal bleeding is seen. Abruptions are graded according to the percentage of the placental surface that detaches (see Table 3). Visual inspection of an abrupted placenta reveals circumscribed depressions on its maternal surface and is covered by dark, clotted blood. Destruction and loss of function of the placenta result in fetal distress, neurological deficits such as cerebral palsy, or fetal death.

Grading System for Abruptions

Grade 0	Less than 10% of the total placental surface has detached; the patient has no symptoms; however, a small retroplacental clot is noted at birth.
Grade I	Approximately 10%–20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress.
Grade II	Approximately 20%–50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock.
Grade III	More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

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