Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT

Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT made by sonal Patel

1. Abruptio
Placenta
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2. Definition
•It is one form of Antepartum Hemorrhage
where the bleeding occurs due to
premature separation of a normally
situated placenta
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3. Incidence
•0.5% -1% of all deliveries
•Decreasing trend
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4. Risk factors
•Increased age and parity
•Preeclampsia
•Chronic hypertension
•Preterm ruptured membranes
•Multi fetal gestation
•Polyhydramnios
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5. Risk factors
•Cigarette smoking
•Thrombophilias
•Cocaine use
•Prior abruption
•Uterine leiomyoma
•External Trauma
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6. Retroplacental decidual hematoma
•Separation, compression and destruction
of adjacent placenta
•Varieties: Concealed, Revealed & mixed
•Couvelaire uterus
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PATHOLOGY

7. Clinical Features
Sign / symptom Frequency%
Vaginal bleeding 78
Uterine tenderness
back pain
66
Fetal distress 60
Preterm labor 22
Hypertonic contractions 17
Hyper tonus 17
Dead fetus 15
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8. Diagnosis…
Essentially a clinical diagnosis
•Painful bleeding
•Abdominal findings
•Cardiotocographic Monitoring
•AFP
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9. 9
Cardiotocograph

10. Role of ultrasound –limited
•Negative findings do not exclude
the diagnosis
•U/S is mainly used to confirm fetal
viability, Presentation & position.
•To exclude Placenta praevia
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11. Classification
Grade 0:Retrospective diagnosis.
Grade 1:External bleeding present, no fetal
or maternal complication
Grade 2:External bleeding +/-,
tense & tender uterus, Fetal
distress/death
Grade 3:External bleeding +/-
tense & tender uterus, fetal death with
maternal shock .
DIC, Renal failure
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12. Consumptive Coagulopathy
•Delee (1901) Temporary hemophilia
Parameters:Fibrinogen < 150 mg/dl,
•elevated FDP, D-dimers, decrease in other
coagulation factors
Mechanism:DIC & retro placental clot
formation
•Seen in 30% cases of abruption severe
enough to kill the fetus
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13. Acute Renal failure
•Pathology:Acute tubular necrosis (75%)
& acute cortical necrosis (25%)
•Mechanism:Severe hypovolemia , DIC
along with Underlying preeclampsia
•Prevention:Prompt & vigorous
replacement of blood and circulating blood
volume
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14. Differential Diagnosis
1.Without pain: Placenta Previa
2.Without Bleeding: Acute degeneration
or torsion of a fibroid, hematoma of
rectus sheath, rupture of an
appendicular abscess.
3.With mild pain & bleeding: Labour with
heavy show
4.Rupture Uterus
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15. Management
Initial assessment
•Monitor vital signs: BP –poor guide to
the extent of bleeding.
•Mark the fundalheight & measure
abdominal girth
•cardiotocographicmonitoring of fetus
Investigations: HB, PCV, blood grouping
& typing, BT CT, Clot retraction & lyses,
DIC profile
•Foley catheterization & hourly output
chart
•watch for bleeding
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16. Management
“Swift & decisive”
Resuscitatethe mother
•Start an IV line, transfuse Ringer lactate, N
Saline
•Two lines if bleeding is severe
•Replace blood loss and maintain circulation
•Maintain PCV at 30% & urine output >30
ml/hr.
•CVP in difficult cases
•Delivery
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17. Management
Caesarian section
•Live & mature fetus
•Delivery not imminent
•Fetal distress
•No response to induction of labour
•Bleeding
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18. Management
Vaginal delivery
•Preferred if fetus is dead.
•In Selected cases with a live fetus
•ARM with oxytocin
•Watch for PPH
•RH prophylaxis
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19. Management
Expectant line of management
•Doubtful diagnosis
•Minor abruption
•Preterm gestation
•Intensive surveillance & Induction at
or before term
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20. Perinatal mortality
•Main danger is to the fetus. If the
abruption is severe enough to threaten the
mother, the fetus will usually be dead
25 fold increase in PMR
•Still birth
•Prematurity
•Hypoxia
•Cerebral palsy
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21. Maternal deaths due to hemorrhage
Causes of hemorrhage Percentage
Abruption 19
Uterine rupture 16
Atonic PPH 15
Coagulopathies 14
Placenta praevia 7
Uterine bleeding 6
placenta accreta/percreta 6
Retained placenta 4
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22. Maternal mortality
Case report:woman, who seemed well
enough to wait in an emergency dept for 2
hrs. When the doctor saw her at the end
of this time she was dead!!!
“a fit woman may be able to compensate
for severe hemorrhage until collapse
occurs as a terminal event”
•A reminder –need to maintain high
standards in obstetric care
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