placental abruption n.
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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

Placental Abruption

Liu Wei

Department of Ob & Gy

Ren Ji hospital

general consideration
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
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
pathology
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
manifestation
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
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.
diagnosis
Diagnosis
  • sign and symptom
  • Vaginal bleeding
  • Uterine tenderness or back pain
  • Fetal distress
  • High frequency contractions
  • Hypertonus
  • Idiopathic preterm labor
  • Dead fetus
diagnosis1
Diagnosis
  • Ultrasonography
  • Differential diagnosis
  • Placenta previa

Painless bleeding

  • Pre-rupture of uterus

dystocia

complication
Complication
  • DIC
  • Hypovolemic shock
  • Amnionic fluid embolism
  • Acute renal failure
treatment
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
treatment1
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