Placental Abruption
Liu Wei
Department of Ob & Gy
Ren Ji hospital
General Consideration
? Definition
The separation of the placenta from its site of
implantation after 20 weeks of gestation or
during the course of delivery,
? Frequency
0.51%-2.33% (our country)
1% (other countries)
? Incidence of fetal death
200‰ -350‰
Etiology
? Uncertain (primary cause)
? Risk factors
1,Increased age and parity
2,Vascular diseases,preeclampsia,chronic
hypertension,renal disease,
3,Mechanical factors,trauma,intercourse,
polyhydramnios,
4,Supine hypotensive syndrome
5,Smoking,cocaine use,uterine myoma
Pathology
? Main change
hemorrhage into the decidua basalis → decidua
splits → decidural hematoma → separation,
compression,destruction of the placenta
adjacent to it
? Types
revealed abruption,concealed abruption,
mixed type
? Uteroplacental apoplexy 子宫胎盘卒中
Pathology
Manifestation
? Vaginal bleeding companied with abdominal
pain
? Mild type
abruption≤ 1/3,apparent vaginal bleeding
? Severe type
abruption > 1/3,large retroplacental hematoma,
vaginal bleeding companied by persistent
abdominal pain,tenderness on the uterus,
change of fetal heart rate,shock and renal
failure,
Adjunctive Examination
? Ultrasonography
1,Position of placenta,severity of abruption,
survival of fetus
2,Signs,retroplacental hematoma
3,Negative findings do not exclude placental
abruption
? Laboratory examination
1,consumptive coagulopathy,Rt,DIC
2,Function of liver and kidney,
Diagnosis
? sign and symptom
1,Vaginal bleeding
2,Uterine tenderness or back pain
3,Fetal distress
4,High frequency contractions
5,Hypertonus
6,Idiopathic preterm labor
7,Dead fetus
Diagnosis
? Ultrasonography
? Differential diagnosis
1,Placenta previa
Painless bleeding
2,Pre-rupture of uterus
dystocia
Complication
? DIC
? Hypovolemic shock
? Amnionic fluid embolism
? Acute renal failure
Treatment
? Treatment will vary depending upon
gestational age and the status of mother and
fetus
? Treatment of hypovolemic shock,intensive
transfusion with blood
? Assessment of fetus
? Termination of pregnancy,CS or Vaginal
delivery
Treatment
? Treatment of consumptive coagulopathy
1,Supplement of coagulation factors,fresh
blood,frozen blood plasma,fibrinogen,blood
platelet,
2,Heparin,high coagulation
3,Anti-fibrinolysis
? Prevention of renal failure
END
Liu Wei
Department of Ob & Gy
Ren Ji hospital
General Consideration
? Definition
The separation of the placenta from its site of
implantation after 20 weeks of gestation or
during the course of delivery,
? Frequency
0.51%-2.33% (our country)
1% (other countries)
? Incidence of fetal death
200‰ -350‰
Etiology
? Uncertain (primary cause)
? Risk factors
1,Increased age and parity
2,Vascular diseases,preeclampsia,chronic
hypertension,renal disease,
3,Mechanical factors,trauma,intercourse,
polyhydramnios,
4,Supine hypotensive syndrome
5,Smoking,cocaine use,uterine myoma
Pathology
? Main change
hemorrhage into the decidua basalis → decidua
splits → decidural hematoma → separation,
compression,destruction of the placenta
adjacent to it
? Types
revealed abruption,concealed abruption,
mixed type
? Uteroplacental apoplexy 子宫胎盘卒中
Pathology
Manifestation
? Vaginal bleeding companied with abdominal
pain
? Mild type
abruption≤ 1/3,apparent vaginal bleeding
? Severe type
abruption > 1/3,large retroplacental hematoma,
vaginal bleeding companied by persistent
abdominal pain,tenderness on the uterus,
change of fetal heart rate,shock and renal
failure,
Adjunctive Examination
? Ultrasonography
1,Position of placenta,severity of abruption,
survival of fetus
2,Signs,retroplacental hematoma
3,Negative findings do not exclude placental
abruption
? Laboratory examination
1,consumptive coagulopathy,Rt,DIC
2,Function of liver and kidney,
Diagnosis
? sign and symptom
1,Vaginal bleeding
2,Uterine tenderness or back pain
3,Fetal distress
4,High frequency contractions
5,Hypertonus
6,Idiopathic preterm labor
7,Dead fetus
Diagnosis
? Ultrasonography
? Differential diagnosis
1,Placenta previa
Painless bleeding
2,Pre-rupture of uterus
dystocia
Complication
? DIC
? Hypovolemic shock
? Amnionic fluid embolism
? Acute renal failure
Treatment
? Treatment will vary depending upon
gestational age and the status of mother and
fetus
? Treatment of hypovolemic shock,intensive
transfusion with blood
? Assessment of fetus
? Termination of pregnancy,CS or Vaginal
delivery
Treatment
? Treatment of consumptive coagulopathy
1,Supplement of coagulation factors,fresh
blood,frozen blood plasma,fibrinogen,blood
platelet,
2,Heparin,high coagulation
3,Anti-fibrinolysis
? Prevention of renal failure
END
