ostetrical hemorrhage.ppt

7/27/2019 Ostetrical Hemorrhage.ppt

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OSTETRICAL HEMORRHAGE


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Generally speaking, obstetrical hemorrhage may be

antepartumsuch as with placenta previa or

placental abruption

More commonly it ispostpartumfrom uterine

atony or genital tract lacerations.


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ANTEPARTUM HEMORRHAGE


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PLACENTAL ABRUPTION

Placental separation from its implantation site beforedelivery has been variously called placental abrup t ion,abrupt io placentae, and in Great Britain, accidentalhemorrhage

The Latin term abrupt io placentaemeans rendingasunder of the placentaand denotes a suddenaccident, which is a clinical characteristic of most cases.

The bleeding of placental abruption typically inisuatesitself between the membrane and uterus, ultimatelyescaping from the cervix, causing external hemorrhage

Concealed hemorrhage - the blood does not escapeexternally but is retained between the detached placentaand the uterus


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Abruptio placenta

Total

Partial


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ETIOLOGI/RISK FACTORS

Parity

Age

Race

Familial

Factors

Hypertension

SmokingCocaine

Trombhophilias

PROM &

PrematureDelivery

Leiomyomas

Traumatic

Abruptions

Recurrent

abruption


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PATHOLOGY


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CLINICAL DIAGNOSIS

Vaginal bleeding

78% Uterine tenderness and back pain 66%

Fetal distress 60%

Others frequent uterine contractions and persistent

uterine hypertonus


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COMPLICATIONS

Shock

Consumptive coagulopathy

Renal Failure

Sheehan Syndrome Couvelaire uterus


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MANAGEMENT


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Caesarean delivery

Vaginal delivery


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PLACENTA PREVIA

Placenta previa is used to describe a placenta that

is implanted over or very near the internal cervicalos. There are several possibilities:

Total placenta previathe internal os is covered

completely by placenta (Fig. 35-11)

Partial placenta previa

the internal os is partiallycovered by placenta (Fig. 35-12)

Marginal placenta previathe edge of the placenta is at

the margin of the internal os

Low-lying placentathe placenta is implanted in the

lower uterine segment such that the placental edgedoes not reach the internal os, but is in close proximity

to it

Vasa previathe fetal vessels course through

membranes and present at the cervical os


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ASOCCIATED FACTORS

Maternal Age

Cesarean

delivery

Multiparity

Smoking

Elevated Maternal

Serum Alfa-

Fetoprotein

(MSAFP)


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CLINICAL FINDINGS

Painless hemorrhage

Placenta accreta, increta and percreta

Coagulation defects


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DIAGNOSIS

Placenta previa or abruption should always be

suspected in women with uterine bleeding during

the latter half of pregnancy

Digital cervival examination is never permissible

USG

Transabdominal sonography

Transvaginal sonography

Transperineal sonography


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MANAGEMENT

Women with a previa may be considered in one of

the following categories:

The fetus is preterm and there are no other indications

for delivery

The fetus is reasonably mature

Labor has ensued

Hemorrhage is so severe as to mandate delivery

despite gestational age.


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DELIVERY

Because of the poorly contractile nature of the

lower uterine segment, there may be uncontrollable

hemorrhage following placental removal

Oversewing the implantation site with 0-chromic sutures

bilateral uterine or internal iliac artery ligation

hysterectomy


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TERIMA KASIH

ostetrical hemorrhage.ppt

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