Placenta abruptio
? Alternative names Return to top
? Premature separation of placenta;
Accidental hemorrhage; Ablatio placentae;
Abruptio placentae; Placental abruption
? 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,
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).
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 incidence of recurrence
exceeds 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)
? increased maternal age
? increased number of prior deliveries
? increased uterine distention (as may occur with
multiple pregnancies or abnormally large volume
of amniotic fluid)
? diabetes mellitus in the pregnant woman
? cigarette smoking; cocaine abuse; and drinking
alcohol during pregnancy (more than 14 drinks
per week).
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
Pathologic changes
? Revealed abruption
? Concealed abruption
? Mixed type
? Bloody emniotic fliud
? Uteroplacental apoplexy
? DIC
classification
? Mild type
? Severe type
?1/3
Clinical findings
? Symptoms
? Vaginal bleeding
? Abdominal pain
? Back pain
? Signs and tests
? Physical examination reveals uterine tenderness
and/or increased uterine tone,Hemorrhage or
heavy bleeding in pregnancy may be visible or
concealed.
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)
? Diagnosis
? Differential diagnosis
? Placenta previa
? Threatened rupture of uterus
Complications
? Excessive loss of blood that may lead to
shock and possible fetal and/or maternal
death is the most evident complication,If
the site of placental attachment starts to
hemorrhage after the delivery and loss of
blood cannot be controlled by other means,
a hysterectomy (removal of the uterus) may
become necessary,
Chinese textbook
? Complications
? DIC
? Haemorrhagic shock
? Amniotic fluid embolism
? Acute renal failture
? Intrauterus fetal demise
Treatment
? Correct shock
? Monitoring the state of fetus
? Termination of the pregnancy
? Correct DIC
? Prevention of renal failture
Expectations (prognosis)
? Maternal mortality is uncommon,range from 0.5
to 5%,Early diagnosis of the condition and
adequate 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 is
detectable in about 15% of cases,Fetal distress
appears early in the condition in approximately
50% of cases,The infants who live have a 40 to
50% incidence of illness,
? 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,
? Alternative names Return to top
? Premature separation of placenta;
Accidental hemorrhage; Ablatio placentae;
Abruptio placentae; Placental abruption
? 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,
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).
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 incidence of recurrence
exceeds 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)
? increased maternal age
? increased number of prior deliveries
? increased uterine distention (as may occur with
multiple pregnancies or abnormally large volume
of amniotic fluid)
? diabetes mellitus in the pregnant woman
? cigarette smoking; cocaine abuse; and drinking
alcohol during pregnancy (more than 14 drinks
per week).
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
Pathologic changes
? Revealed abruption
? Concealed abruption
? Mixed type
? Bloody emniotic fliud
? Uteroplacental apoplexy
? DIC
classification
? Mild type
? Severe type
?1/3
Clinical findings
? Symptoms
? Vaginal bleeding
? Abdominal pain
? Back pain
? Signs and tests
? Physical examination reveals uterine tenderness
and/or increased uterine tone,Hemorrhage or
heavy bleeding in pregnancy may be visible or
concealed.
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)
? Diagnosis
? Differential diagnosis
? Placenta previa
? Threatened rupture of uterus
Complications
? Excessive loss of blood that may lead to
shock and possible fetal and/or maternal
death is the most evident complication,If
the site of placental attachment starts to
hemorrhage after the delivery and loss of
blood cannot be controlled by other means,
a hysterectomy (removal of the uterus) may
become necessary,
Chinese textbook
? Complications
? DIC
? Haemorrhagic shock
? Amniotic fluid embolism
? Acute renal failture
? Intrauterus fetal demise
Treatment
? Correct shock
? Monitoring the state of fetus
? Termination of the pregnancy
? Correct DIC
? Prevention of renal failture
Expectations (prognosis)
? Maternal mortality is uncommon,range from 0.5
to 5%,Early diagnosis of the condition and
adequate 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 is
detectable in about 15% of cases,Fetal distress
appears early in the condition in approximately
50% of cases,The infants who live have a 40 to
50% incidence of illness,
? 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,
