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

Abruptio Placenta.

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.

8) Folic acid deficiency

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 :

  1. Ultrasonography.
  2. Blood: Hb% (anaemia).
  3. Blood grouping & Rh typing.
  4. Platelet count.
  5. Clotting time
  6. Prothrombin time (extrinsic coagulation)
  7. Partial thromboplastin time (intrinsic coagulation).
  8. Serum fibrinogen level.
  9. Fibrin degradation product (FDP) 
  10. Urine: For protein.

Treatment of abruptio placentae :

A) General treatment:

  1. A wide bore I/V channel is to be started. 
  2.  I/V fluid; Ringer’s lactate, Hartman’s solution, haemaccel to correct hypovolaemia.
  3.  Blood transfusion: At least 2-4 unit of blood should be transfused.
  4. Inj. 10% Calcium gluconate (10 ml) iv very slowly over 10-20 minutes after each 3 units of blood transfusion.
  5. Bed side clot observation test (Weiner): To monitor coagulation profile
  6. Catheterization: To monitor urine output.
  7. 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:

  1. Haemorrhage → hypovolaemia→ shock.
  2. Postpartum haemorrhage.
  3. Oliguria & anuria→ ARF.
  4. Blood coagulation disorder: DIC.
  5. Sheehan’s syndrome.
  6. Increased operative interference,
  7.  Psychological upset due to increased rate of fetal death.
  8. 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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