Placental Abruption

Overview: 

Placental abruption (abruption placenta) is an uncommon-but serious-complication of pregnancy that requires immediate medical attention. Placental abruption is defined as the separation of the placenta from the inner wall of the uterus, usually after the 20th week of pregnancy. If the placenta erupts and pulls away before the baby is born, not only is the baby at risk, but the mother may have extremely heavy bleeding. 

 1. Pathophysiology:

Vascular Changes

• Uterine vasospasm leads to rupture of decidual arteries, causing blood accumulation (hematoma)

  between the placenta and uterus.

• Hematoma can be concealed (hidden) or revealed (visible bleeding).

Placental Separation and Increased Pressure

• Hematoma expansion leads to progressive placental separation, reducing blood flow to the fetus,

  resulting in hypoxia.

Coagulopathy

• Thromboplastin release from the degenerating decidua triggers DIC, leading to widespread clotting

  and ischemia.

Maternal and Fetal Impact

• Maternal: Hypovolemic shock, DIC, liver and kidney dysfunction.

• Fetal: Hypoxia, preterm birth, potential stillbirth.

2. Symptoms: 

• Vaginal bleeding 

• Abdominal pain 

• Back pain 

• Uterine tenderness 

• Rapid uterine contractions, often coming one right after another 

3. Risk Factors: 

• Advanced maternal age (40 and older) 

• Previous cases of placental abruption 

• Membrane rupture 

• Blood clot disorders 

• Carrying twins, triplets (more than one baby) 

• Smoking and/or using illegal drugs 

• Diabetes 

• High blood pressure 

4. Treatment: 

Treatment may include fluids through a vein (IV) and blood transfusions. The mother will be carefully monitored for symptoms of shock. The unborn baby will be watched for signs of distress, which includes an abnormal heart rate. An emergency cesarean section may be needed.  

If the baby is very premature and there is only a small placental separation, the mother may be kept in the hospital for close observation. If the fetus is developed enough, vaginal delivery may be done if it is safe for the mother and child. Otherwise, a cesarean section will be done. If the placenta has completely separated, the best course of action is usually to deliver the infant before the lack of oxygen and blood flow may create long-term health issues and disorders. In addition, the infant may be at risk for fetal death. 

5. Effects on Neonate: 

• Premature birth 

• Still birth 

• Growth issues 

Cerebral Palsy (CP) can develop for various reasons, including placental eruption. Since infants lose oxygen when placental eruption occurs, the lack of oxygen may lead to brain damage, which in turn may lead to CP. 

6. Prognosis: 

The mother does not usually die of this condition. But any of the following increases the risk of death for both the mother and baby: 

• Closed cervix 

• Delayed diagnosis and treatment of placental abruption 

• Excessive blood loss, leading to shock 

• Hidden (concealed) uterine bleeding in pregnancy 

• No labor 

Fetal distress occurs early in the condition in about half of all cases. Infants who live have a 40-50% chance of complications, which range from mild to severe. 

What does a NICU RT have to consider when dealing with placental abruption? 

Placental abruption is of crucial importance to a NICU (Neonatal Intensive Care Unit) therapist as it can significantly impact the health and well-being of newborns. Placental abruption involves the premature separation of the placenta from the uterine wall, potentially leading to oxygen and nutrient deprivation for the fetus. This condition may result in preterm birth, low birth weight, and respiratory distress syndrome in newborns. NICU therapists must be prepared to address the respiratory consequences of premature birth, providing immediate and specialized care such as respiratory support, surfactant therapy, and monitoring for potential complications like apnea and bradycardia. Additionally, they may need to collaborate closely with a multidisciplinary team to manage other complications associated with placental abruption, ensuring comprehensive care for infants affected by this obstetric emergency.