08 placenta abruptio

8/4/2019 08 Placenta Abruptio

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Placenta abruptio


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Definition

(after the 20th week or during delivery)The

separation of the placenta(in normal site)

from the site of uterine implantation before

delivery of the fetus.


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Causes Direct causes (1 to 5%).

mechanical factors such as abdominal trauma (for

example, from an auto accident or fall) sudden loss in uterine volume ( rapid loss of

amniotic fluid or the delivery of a first twin0

abnormally short umbilical cord (usually only a

problem at the time of delivery).


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Predisposing factors a past medical history of placenta abruptio (after

1 prior episode there is a 10 to 17% recurrence,

after 2 prior episodes the incidenceof recurrenceexceeds 20%)

hypertension or high blood pressure during

pregnancy is associated with 2.5 to 17.9%

incidence (however, approximately 50% of

placenta abruptio cases severe enough to cause

fetal death are associated with hypertension)
http://www.nlm.nih.gov/medlineplus/ency/article/002387.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003082.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001488.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001488.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003082.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002387.htm


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increased maternal age

increased number of prior deliveries

increased uterine distention (as may occur withmultiple pregnancies or abnormally large volumeof amniotic fluid)

diabetes mellitus in the pregnant woman

cigarette smoking; cocaine abuse; and drinkingalcohol during pregnancy (more than 14 drinks

per week).
http://www.nlm.nih.gov/medlineplus/ency/article/001214.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002032.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002032.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001214.htm


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Incidence The incidence of placenta abruptio,

including any amount of placental

separation prior to delivery, is about 1 out

of 150 deliveries. However, the severe

form (resulting in fetal death) occurs only

in about 1 out of 500 to 750 deliveries


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Pathologic changes Revealed abruption

Concealed abruption

Mixed type

Bloody emniotic fliud

Uteroplacental apoplexy DIC


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classification Mild type

Severe type

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Clinical findings Symptoms

Vaginal bleeding

Abdominal pain Back pain

Signs and tests

Physical examination reveals uterine tendernessand/or increased uterine tone. Hemorrhage orheavy bleeding in pregnancy may be visible orconcealed.
http://www.nlm.nih.gov/medlineplus/ency/article/003156.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003108.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002274.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000045.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000887.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000045.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002274.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003108.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003120.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003156.htm


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Tests A CBC, may note decreased hematocrit or

hemoglobin and platelets

Prothrombin time test

Partial thromboplastin time test

Fibrinogen level test Abdominal ultrasound (may be done)
http://www.nlm.nih.gov/medlineplus/ency/article/003642.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003646.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003645.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003647.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003652.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003653.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003650.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003777.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003777.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003650.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003653.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003652.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003647.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003645.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003646.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003642.htm


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Diagnosis Differential diagnosis

Placenta previa

Threatened rupture of uterus


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Complications

Excessive loss of blood that may lead toshockand possible fetal and/or maternal

death is the most evident complication. If

the site of placental attachment starts tohemorrhage after the delivery and loss of

blood cannot be controlled by other means,

a hysterectomy (removal of the uterus) may

become necessary.
http://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002915.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002915.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htm


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Chinese textbook Complications

DIC

Haemorrhagic shock

Amniotic fluid embolism

Acute renal failture

Intrauterus fetal demise


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Treatment Correct shock

Monitoring the state of fetus

Termination of the pregnancy

Correct DIC

Prevention of renal failture


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Expectations (prognosis) Maternal mortality is uncommon: range from 0.5to 5%. Early diagnosis of the condition andadequate intervention should decrease the

maternal death rate to 0.5 to 1%. Fetal death rates range from 20-35 %. Upon

hospital admission, no fetal heart tone isdetectable in about 15% of cases. Fetal distress

appears early in the condition in approximately50% of cases. The infants who live have a 40 to50% incidence of illness.
http://www.nlm.nih.gov/medlineplus/ency/article/001488.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002387.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002387.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001488.htm


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Concealed vaginal bleeding in pregnancy,

excessive loss of blood resulting in shock,

absence of labor, a closed cervix, and

delayed diagnosis and treatment are

unfavorable factors that may increase the

risk of maternal or fetal death.
http://www.nlm.nih.gov/medlineplus/ency/article/003264.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002317.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002317.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000039.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/003264.htm

08 placenta abruptio

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