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Placental Abruption

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)

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Placental Abruption

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  1. Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital

  2. 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‰

  3. Etiology • Uncertain (primary cause) • Risk factors • Increased age and parity • Vascular diseases: preeclampsia, chronic hypertension, renal disease. • Mechanical factors: trauma, intercourse, polyhydramnios, • Supine hypotensive syndrome • Smoking, cocaine use, uterine myoma

  4. 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

  5. Pathology

  6. 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.

  7. Adjunctive Examination • Ultrasonography • Position of placenta, severity of abruption, survival of fetus • Signs: retroplacental hematoma • Negative findings do not exclude placental abruption • Laboratory examination • consumptive coagulopathy: Rt, DIC • Function of liver and kidney.

  8. Diagnosis • sign and symptom • Vaginal bleeding • Uterine tenderness or back pain • Fetal distress • High frequency contractions • Hypertonus • Idiopathic preterm labor • Dead fetus

  9. Diagnosis • Ultrasonography • Differential diagnosis • Placenta previa Painless bleeding • Pre-rupture of uterus dystocia

  10. Complication • DIC • Hypovolemic shock • Amnionic fluid embolism • Acute renal failure

  11. 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

  12. Treatment • Treatment of consumptive coagulopathy • Supplement of coagulation factors: fresh blood, frozen blood plasma, fibrinogen, blood platelet. • Heparin: high coagulation • Anti-fibrinolysis • Prevention of renal failure

  13. END

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