Definition
Abruptio Placentae is a partial or complete detachment of the placenta from normal implantation ( corpus uteri ) after 20 weeks and before the fetus is born .
Etiology
Primary cause is not known for sure , but there are several factors that predispose
1. Factor cardio - renal - vascular
Chronic glomerulonephritis, essential hypertension, preeclampsia and eclampsia syndrome. In studies in Parkland, found that half of the cases there is hypertension in severe abruptio placentae, and half of the hypertensive women who have chronic hypertension, the rest hypertension caused by pregnancy.
2. Factors trauma
Decompression of the uterus in hydramnion and gemeli.
Pull the cord is short, due to the many fetal movement / free versions out or delivery assistance measures.
Direct trauma, such as falls, contact with kick, and others.
3. Factors maternal parity
More common in multiparous than primiparous. Some studies explain that higher maternal parity increasingly unfavorable state of the endometrium.
4. Factors maternal age
The older age of the mother, the higher the frequency of chronic hypertension.
5. Uterine leiomyoma are pregnant can cause placental abruption when the placenta implants in the upper part containing leiomyomas.
6. The use of cocaine
The use of cocaine resulted in elevated blood pressure and increased release of catecholamines are responsible for the occurrence of vasospasm uterine blood vessels and result in placental abruption. However, this hypothesis has not been proven definitively.
7. Factors smoking
Mothers who smoke also causes an increase in cases of placental disruption of up to 25 % in women who smoke ≤ 1 (one) pack per day. This can be explained in mothers who smoked the placenta becomes thinner, wider diameter and several abnormalities in the microcirculation.
8. History placental abruption before
It is very important and determines the prognosis of women with a history of placental abruption is that the risk of a repeat of this incident in a subsequent pregnancy is much higher compared with pregnant women who do not have a history of placental disruption.
9. Other influences, such as anemia, malnutrition / nutritional deficiencies, uterine pressure on the inferior vena cava due to the enlargement of the size of the uterus by the presence of pregnancy, and others.
Complication
1. Shock bleeding
Antepartum and intrapartum bleeding in placental abruption can hardly be prevented, except to resolve immediate delivery. If delivery has been completed, the patient has not been free of postpartum hemorrhage due to uterine contractions are not strong enough to stop the bleeding in the third stage. In a state of shock severe placental disruption often does not match the number of visible bleeding.
2. Kidney failure
Kidney failure is a frequent complication in patients with abruptio placentae, basically due to the state of hypovolemia due to bleeding that occurs. Renal tubule necrosis usually occurs suddenly, which generally still be helped with good handling.
3. Abnormalities of blood coagulation
Blood clotting disorder usually caused by hipofibrinogenemia.
4. uteroplacental apoplexy (Couvelaire uterus)
In severe placental abruption, bleeding in the muscles of the uterus and under perimetrium sometimes also in the broad ligament. This bleeding cause uterine contractility and uterine color change to blue or purple commonly called Couvelaire uterus.
Complications that can occur in the fetus :
Fetal distress , Impaired growth / development , hypoxia , anemia , Death
3 Nursing Diagnosis for Abruptio Placentae
1. Ineffective Tissue perfusion (peripheral)
2. Acute pain
3. Anxiety