Placental abruption and preeclampsia

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We had a pt come in yesterday at 1800 with severe abdominal pain and a LARGE amt of bright red bleeding - just soaking the wheelchair and then the stretcher we put her on. Took her to triage, first could find hearttones and then could not . . . ran her back to the OR and another OB who was not even her doctor started her surgery. Apgars 1 and 7. Baby was resuscitated by the high risk team and then transfered to the newborn nursery.

This pt had been in for observation related to preeclampsia earlier that day and had been discharged home.

I attended an AWHONN meeting a couple months ago about preeclampsia and am amazed that some 40-some-odd % of abruptions occur in this pt population. Maybe I just have not thought it through completely enough, but can anyone tell me why these pt's are at such high risk for abruption?

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Specializes in ICU.

We studied this phenomena in the OB class I took last semester. Hypertensive mothers (pre-eclamptic) tend to have decreased blood flow to the placenta, which is probable cause of abrupto placentae. One patient I had in clinicals last semester was hypertensive and gave birth to child that was barely AGA, but could have easily been classified as SGA. The staff thought maybe the EDB was off, but then I remembered that hypertensive mothers have decreased placental perfusion and it all made sense!

Hope this helps :)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Decreased placental perfusion, hypertensive state in placenta, calcified vessels that do not prefuse well----and it's at high risk to abrupt as a result. It's like a cooking pot ready to boil in my mind.

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Specializes in L&D, Family Practice, HHA, IM.

Several months ago, in the unit, we had a G1P0 woman who was due to give birth to twins. She was also pre-eclamptic and her bottom BP number was 136 and her urine was dipping 4+.

The day of the scheduled C/S she was prepped and ready to go in the OR when she suddenly seized. She was quickly stabilized and rushed into surgery. When her OB opened her up, one of the placentas had abrupted and the pt lost a lot of blood.

Fortunately, both babies and their mother survived, but not after the mother spent a long time in L&D and the babies in the NICU.

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We had this happen several years ago - a 28 weeker with severe preecclampsia who was awaiting transport to a larger center suddenly abrupted and we had to do a stat c-section for a 28 weeker (we have no NICU). It was quite a big deal for us. I did a lot of reading after that and it has to do with the decreased perfusion coupled with the high pressures in the vessels. I think of it as the high pressure literally "blowing off" the placenta.

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I think of it as the high pressure literally "blowing off" the placenta.

What a great analogy! Thanks everyone for your responses - it makes sense. I knew that those moms have decreased perfusion to the placenta, I just did not really understand why that made them at increased risk for abruption.

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