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SEPARATION OF
THE PLACENTA
Abruptio Placentae
Abruptio
Placenta
Placenta is implanted
correctly
Suddenly separates and
bleeding results
10% of pregnancies
Most frequent cause of
perinatal death
Occurs late in pregnancy
Abruptio
Placenta
Cause is unknown
Chorioamnionitis
an infection of the fetal
membranes and fluid
Predisposing
factors:
High parity
Advanced maternal age
Short umbilical cord
Chronic hypertensive disease
Pregnancy induced hypertension
Direct trauma (as from an automobile
accident or intimate partner abuse)
Vasoconstriction from cocaine or
cigarette use
Thrombophilitic conditions that lead to
thrombosis such as autoimmune
antibodies, protein C, and factor V Leiden
(a common inherited thrombophilia that
occurs in 5% of whites and 1% of blacks
Assessment
Assessment
Assessment
Therapeutic
Management
An emergency situation
IV insertion (using large catheter) for fluid
replacement
Oxygen by mask to limit fetal anoxia
Monitor fetal heart sounds
Record maternal vital signs every 5 to 15
minutes to establish baselines and
observe progress
Baseline fibrinogen determination
Keep a woman in a lateral, not supine,
position to prevent pressure on the vena
cava and additional interference with fetal
circulation
Therapeutic
Management
Therapeutic
Management
Intravenous administration of
fibrinogen or cryoprecipitate
(which contains fibrinogen) may
be used to elevate a womans
fibrinogen level prior to and
concurrently with surgery
With the worst outcome, a
hysterectomy might be
necessary to prevent
exsanguination
Fetal
prognosis
Maternal
prognosis
Depends on how
promptly treatment
can be instituted
PREMATURE
SEPARATION OF THE
PLACENTA:
DEGREES OF
SEPARATION
Degrees
of
Separation
Premature
Separation
of the
Placenta