Abruptio placentae (Early separation of placenta)

Abruptio placenta is defined as one form of antepartum haemorrhage where the bleeding
occurs due to premature separation of normally situated placenta. It is also called
placental abruption.

Varieties -
1. Revealed - Following separation of the placenta, the blood insinuates downwards
between the membranes and the decidua. Ultimately, the blood comes out of the cervical
canal to be visible externally. This is the commonest type.

2. Concealed - The blood collects behind the separated placenta or collected in between
the membranes and decidua. The collected blood is prevented from coming out of the
cervix by the presenting part which presses on the lower segment. At this times,
the blood may percolate into the amniotic sac after rupturing the membranes. In any of
the circumstances blood is not visible outside. This type is rare.

3. Mixed - In this type, some type of the blood collects inside (concealed) and a part is
expelled out (revealed).

Incidence - The overall incidence is about 1 in 150 deliveries.

Etiology -
- Hypertension in pregnancy.
- Trauma.
- Sudden uterine decompression.
- Short cord.
- Sick cord.
- Folic acid deficiency.
- cocaine abuse.

Clinical classification -

Depending upon the degree of placental abruption and its clinical effects, clinical classification 

is as follows:

Class 0 (Asymptomatic) - characteristics include the following:

• - Clinical feature may be absent.
• - The diagnosis is made after inspection of placenta following delivery.

Class 1 (Mild) - characteristics include the following:

• - External bleeding is slight.
• - Slightly tender uterus.
• - Normal maternal BP and heart rate.
• - No fetal distress.

Class 2 (Moderate) - characteristics include the following:

• - Vaginal bleeding mild to moderate.
• - Uterine tenderness is always present.
• - Maternal tachycardia.
• - Fetal distress.
• - Shock is absent.

Class 3 (Severe) - characteristics include the following:

• - Bleeding is moderate to severe or may be concealed.
• - Very painful tetanic uterus.
• - Maternal shock is pronounced.
• - Fetal death.
• - Shock is pronounced.

Sign and symptoms -

- Dark red bleeding.

- Abdominal pain and bleeding.

- Shock.

- PIH (pregnancy induced hypertension).

- Anemia.

- Pre-eclampsia.

- Uterine tenderness and hard.

- Low Hb level.

- Headache and vomiting may be present.

Management - 

Prevention -

- To detect the causes which produce placental separation. 

- To minimize and correct the anemia during antenatal period.

- Avoidance of trauma.

- To avoid sudden decompression of the uterus.

- Routine administration of folic acid.