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Placental Abruption Placental Abruption

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Page 1: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 2: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 3: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

� � � � �� � �� � � � �� � ���� � � � � �� � �� � �� � �� � �� ��� � ��� � � �� � �� � �� � �� � �� ��� � ������ ���� ���� � � � � � �� �� � ��Placental Abruption Placental Abruption

((AbruptioAbruptio placentaeplacentae ))

�� Placental Abruption is the separation of the Placental Abruption is the separation of the placenta from the uterine wall before placenta from the uterine wall before deliverydelivery

Marginal separation Marginal separation

Partial separationPartial separation

Complete separation with concealed Complete separation with concealed hemorrhage hemorrhage

Page 4: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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AbruptionAbruption

�� Grade IGrade I

�� Grade IIGrade II

�� GradeIIIGradeIII

III AIII A

III BIII B

Mild, often identified at Mild, often identified at

delivery with delivery with retroplacentalretroplacental

clot clot

Symptomatic, tender Symptomatic, tender

abdomen and live fetusabdomen and live fetus

Severe, with fetal demise Severe, with fetal demise

-- without without coagulopathycoagulopathy

(2/3) (2/3)

-- with with coagulopathycoagulopathy (1/3)(1/3)� �� � �� � �� � � � � � � � � � � � �� � � �� �� � � � � � �� � � � � � � � �� � � �� � � � � � � � � � �� � � � � �� �� ��� � � ! " � # � $ � � % " & �

Page 5: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 6: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 7: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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�� Chronic hypertensionChronic hypertension

�� MultiparityMultiparity

�� PreeclampsiaPreeclampsia

�� Advanced maternal ageAdvanced maternal age

�� Previous abruptionPrevious abruption

�� Short umbilical cordShort umbilical cord

�� Sudden decompression of an Sudden decompression of an overdistendedoverdistendeduterusuterus

�� ThrombophiliasThrombophilias

�� Tobacco, cocaine, or methamphetamine useTobacco, cocaine, or methamphetamine use

�� TraumaTrauma

�� Unexplained elevated maternal alpha Unexplained elevated maternal alpha fetoprotein levelfetoprotein level

�� Uterine fibroidsUterine fibroids

Page 8: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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�� Women often present with the following:Women often present with the following:

Painful vaginal Painful vaginal bleedingbleeding

�� Bleeding may not be visibleBleeding may not be visible

Abdominal or back Abdominal or back painpain and uterine and uterine tenderness tenderness

Fetal distress Fetal distress

Abnormal Abnormal uterine contractions uterine contractions ( hypertonic, ( hypertonic, high frequency) high frequency)

Idiopathic Idiopathic premature laborpremature labor

Fetal death Fetal death

�� DIC may result from the release of DIC may result from the release of thromboplastinthromboplastin into the maternal circulation into the maternal circulation with placental separation with placental separation

Page 9: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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�� Any pregnant woman who presents Any pregnant woman who presents with significant vaginal bleeding needs with significant vaginal bleeding needs evaluation evaluation

History and PhysicalHistory and Physical

�� Never do Never do digital exam digital exam without without knowing placental placement! knowing placental placement!

�� Ultrasound will show abruption in Ultrasound will show abruption in 25% 25% of casesof cases

Often hard to distinguish clots on U/S Often hard to distinguish clots on U/S

�� Diagnosis is based on Diagnosis is based on clinical picture clinical picture once other causes have been excludedonce other causes have been excluded

May not have definite diagnosis until clot May not have definite diagnosis until clot or indentation is seen on placenta after or indentation is seen on placenta after deliverydelivery

Page 10: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 11: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 12: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 13: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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AbruptionAbruption

�� Assess fetal and maternal stabilityAssess fetal and maternal stability

�� AmniotomyAmniotomy

�� IUPC to detect elevated uterine tone IUPC to detect elevated uterine tone

�� Expeditious operative or vaginal deliveryExpeditious operative or vaginal delivery

�� Maintain urine output > 30 cc/hr, Maintain urine output > 30 cc/hr, hematocrithematocrit > 30% > 30%

�� Prepare for neonatal resuscitationPrepare for neonatal resuscitation

�� �� � ��� �� � � � ��� �� � � � � � � � � � � � � � � � �� �� � � �� � �� �� � � � � � � � � � � � � � � � � � � � �� � � � � � � � � � �� � � � � � � �� �� �� � � �� � �� �� � � � � � � � � � � � � � � � � � � � �� � � � � � � � � � �� � � � � � � � � � � ! " " #$ % % "& ' ( )� � � ! " " #$ % % "& ' ( )** ' + #' + #

Page 14: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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AbruptionAbruption

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Page 15: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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AbruptionAbruption

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Page 16: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Stabilizeand deliver

C/Section

ExpectantmanagementDeliver

Fetal lungmaturity

Page 17: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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Page 18: Placental Abruption - nursing.tbzmed.ac.irnursing.tbzmed.ac.ir/uploads/12/CMS/user/file/29/grohe_amozesh/m… · Placental Abruption (Abruptio placentae ) Placental Abruption is the

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