Abruptio Placentae
Abruptio Placenta
Define Abruptio Placenta : It is one from of antepartum hemorrhage where the bleeding occurs due to pre – mature separation of normally situated placenta.
We have described in article :
Causes of abruptio placentae
Symptoms of abruptio placentae
Investigations of abruptio placentae
Treatment of abruptio placentae
Complications of abruptio placentae
Causes of abruptio placentae :
1) Maternal risk factors:
- Multiparity (≥ 5 gravida).
- Advancing maternal age.
- Poor socioeconomic condition.
- Malnutrition.
- Anaemia.
2) Hypertension in pregnancy: Pre-eclampsia, eclampsia.
3) Trauma:
- Attempted external cephalic version especially under anaesthesia using great forces.
- RTA.
- Blow on the abdomen.
- Needle puncture at amniocentesis.
4) Sudden uterine decompression:
- Delivery of the first baby of the twin.
- Sudden escape of liquor amnii in polyhydramnios
- Premature rupture of membranes.
5) Short cord.
6) Supine hypotension syndrome.
7) Poor placentation / sick placenta.
9) Torsion of the uterus
10) Cocaine abuse.
11) Thrombophilias.
Symptoms abruptio placentae :
- Abdominal pain (severe in concealed type).
- Per-vaginal bleeding (in revealed & mixed type).
- Nausea & vomiting.
- There may be history of pre-eclampsia.
- Pallor, features of shock & general condition of the patient is proportionate to the visible blood loss (in revealed type) and not proportionate (in concealed type).
- Vaginal bleeding in revealed type.
- Height of uterus: More than gestational period in concealed type & normal in revealed type.
- Feeling of uterus: Woody hard & tender in concealed type; normal in revealed type
- Fetal parts: Cannot be demonstrated in concealed type.
- Fetal heart sound: Usually absent in concealed type
- Per-vaginal examination: Dark coloured bleeding in revealed type, and no bleeding in concealed type.
Investigations of abruptio placentae :
- Ultrasonography.
- Blood: Hb% (anaemia).
- Blood grouping & Rh typing.
- Platelet count.
- Clotting time
- Prothrombin time (extrinsic coagulation)
- Partial thromboplastin time (intrinsic coagulation).
- Serum fibrinogen level.
- Fibrin degradation product (FDP)
- Urine: For protein.
Treatment of abruptio placentae :
A) General treatment:
- A wide bore I/V channel is to be started.
- I/V fluid; Ringer’s lactate, Hartman’s solution, haemaccel to correct hypovolaemia.
- Blood transfusion: At least 2-4 unit of blood should be transfused.
- Inj. 10% Calcium gluconate (10 ml) iv very slowly over 10-20 minutes after each 3 units of blood transfusion.
- Bed side clot observation test (Weiner): To monitor coagulation profile
- Catheterization: To monitor urine output.
- Strict monitoring: Malemal P, BP, T, R/R, urine output & FHS (if fetus alive).
B) Specific/obstetric treatment:
1) In concealed variety: ARM + Oxytocin (if needed) → if there is no response and there is fetal distress & oliguria → caesarean section.
2) In revealed variety:
a) Patient in labour: ARM± oxytocin.
b) Patient not in labour:
- >37 weeks; ARM ± oxytocin.
- <37 weeks:
.Continuous PV bleeding: ARM ± oxytocin.
.Bleeding stops: Expectant treatment → Try to continue the pregnancy up to 37 weeks.
Complications of abruptio placentae:
Maternal complications:
- Haemorrhage → hypovolaemia→ shock.
- Postpartum haemorrhage.
- Oliguria & anuria→ ARF.
- Blood coagulation disorder: DIC.
- Sheehan’s syndrome.
- Increased operative interference,
- Psychological upset due to increased rate of fetal death.
- Risk of recurrence.
Fetal complications : Fetal death (due to placental separation→ prematurity & anoxia).
- In concealed type: 25-30%.
- In revealed type: 50-100%.
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