انفصال المشيمة

Definition

Placental abruption is separation of the placenta from the uterine wall before the baby is born, fully or partly.

Risk factors

Hypertension and pre-eclampsia, abdominal trauma such as car accidents, smoking, cocaine, previous abruption and premature rupture of membranes.

Symptoms

• Bleeding with severe abdominal pain
• Board-like, tender uterus
• Frequent contractions
• Bleeding may be concealed behind the placenta, so visible loss looks small despite shock
• Fetal distress on the trace

Complications

Maternal haemorrhagic shock, DIC, and fetal hypoxia or death.

Diagnosis

Mainly clinical; ultrasound may miss it.

Treatment

• Two large-bore IVs, fluids and blood transfusion
• Coagulation studies and maternal-fetal monitoring
• Urgent delivery depending on mother and fetus

Nursing care

• Left lateral position and oxygen
• Monitor vital signs, urine output and fundal height

Exam point

A rising fundal height with a hardening uterus suggests concealed bleeding behind the placenta.