ABRUPTIO PLACENTA
 Placenta abruptio is separation of the placenta (the organ that nourishes the fetus) from the site of uterine implantation before delivery of the fetus.
 It affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th week of pregnancy.
CAUSES: Unknown
RISK FACTORS:
a. Maternal hypertension
b. Advance maternal age
c. Grand multiparity
d. Trauma to the uterus
e. Hydramnios
f. Short umbilical cord
g. Cigarette smoking
TYPES OF ABRUPTIO PLACENTA:
1. MARGINAL ( Overt )
 Evident external bleeding, separation begins at the edges.
2. CENTRAL ( Covert )
 Bleeding not evident, placenta separates at the center.
SIGNS AND SYMPTOMS:
1. Painful dark red vaginal bleeding in covert type.
2. Painful bright red vaginal bleeding in overt.
3. Hard, rigid, firm, broad-like abdomen caused by accumulation of blood behind the placenta w/ fetal parts hard to palpate.
4. Abdominal tenderness due to distention of the uterus w/ blood.
5. Sharp pain over the fundus as placenta separates.
6. Signs of shock and fetal distress as the placenta separate.
CLASSIFICATION ACCORDING TO PLACENTAL SEPARATION:
1. Grade 0 – no symptoms of placental separation, diagnosed after delivery when placenta is examined.
2. Grade 1 – some external bleeding, no fetal distress, slight placental separation, no shock
3. Grade 2 – external bleeding, moderate placental separation, uterine tenderness, some evidence of fetal distress
4. Grade 3 – internal and external bleeding, maternal shock and fetal death

PATOPHYSIOLOGY OF ABRUPTIO PLACENTA MEDICINE:
• Tocolytics: Tocolytics are given to stop contractions if your baby is not ready to be born. Contractions are when the muscles of your uterus tighten and loosen.
• Steroids: Steroid medicine may be given if you need to deliver your baby earlier than expected. Steroids help your baby's lungs to function and prevent breathing problems after he is born.
Nursing Management
1. When placenta abruption is suspected or diagnosed, hospitalization is a must.
2. Monitor maternal blood pressure, pulse rate, respirations, central venous pressure, intake and output and amount of vaginal bleeding q 10 – 15 mins
3. Count the number of pads that the patient uses, weighing them as necessary to determine the amount of blood loss.
4. Provide appropriate management.
a. On admission, place the woman on bed rest in a lateral position to prevent pressure on the vena cava.
b. Insert a large gauge intravenous catheter into a large vein for fluid replacement.
c. Monitor the FHR externally and measure maternal vital signs every 5 to15 minutes. Administer oxygen to the mother by mask.
d. Prepare for cesarean section, which is the method of choice for the birth.
5. Asses the need for immediate delivery. If the client is in active labor and bleeding cannot be stopped with bed rest, emergency cesarean delivery may be indicated.
6. Address emotional and psychosocial needs. Outcome for the mother and fetus depends on the extent of the separation, amount of fetal hypoxia and amount of bleeding.