Placental abruption ( pritish baliyan).pptx

Placental abruption

1. Abruptio placentae Submitted by : pritish baliyan Submitted to : mrs guli mam Group :414 A

2. List of content Definition Types Causes Clinical features Diagnosis Management

3. Definition Placental abruption is the premature separation of the normally implanted placenta from the uterine wall after the 20 th week of gestation until the 2 nd stage of labor. 4

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5. Abruptio placentae Abruptio placentae is also called 'placental abruption’ . It is a type of Antipatum hemorrhage . Definition It is one of Antipatum hemorrhage where the bleeding occures due to premature seperation of normally situated placenta.

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7. Incidence The incidence of placental abruption’ is 0.42% .It tends to recur in 8.8% patients.

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9. Classification Revealed type: Bleeding is revealed. Concealed type: No obvious bleeding. Mixed type: Combination of 1&2 above. In the concealed type(20%), the hemorrhage is confined within the uterine cavity, detachment of the placenta may be complete, and the complications are often severe. In the revealed type(80%) the blood drains through the cervix, placental detachment is more likely to be incomplete, and the complications are fewer and less severe 10

10. Types Revealed The bleeding that occurs behind the placenta trickles down between uterine wall to be revealed at vaginal opening.

11. Placental abruption Concealed Blood fails to trickles down and collects between placenta and uterine wall. Mixed Part of blood trickle down and some part of blood collects behind placenta.

12. Causes Poor socioeconomic status and malnourished Advancing age of mother Smoking Hypertension Previous history of abruption Abdominal trauma Sudden decompression of uterus

13. Etiology Primary cause of P A is uncertain Several associated conditions identified: Increase in age & parity: 1.3-1.5% Chronic hypertension: 1.8-3% Preterm ruptured membranes: 2.4-4.9% Multifetal gestation: 2.1% 14

14. Classification of A P depending on history & investigations Grade O : Asymptomatic –incidental finding of retro placental clot Grade 1 : Vaginal bleeding, no maternal or fetal compromise – uterine tenderness present Grade 2 : Fetal distress No evidence of maternal shock Vaginal bleeding may not be present Grade 3 : Maternal shock & fetal demise present Marked uterine tetany & tenderness Vaginal bleeding may not be present 15

15. Cilinical Grading Grade -0 Clinically remain asymptomatic,diagnosis is made following delivery Grade-1 Mild vaginal bleeding Uterus tenderness may or may not Pain may or may not Shock absent Fsh good

16. Grade – 2 Bleeding mild to moderate Uterus tender Pain present Shock absent fetal distress

17. Grade -4 Moderate to severe vaginal bleeding Marked uterus tenderness Severe degree pain present Shock present Fetal heart sound – fetal death

18. Sign and symptoms Bleeding is present Dark colour bleeding Uterus is tensed Maternal shock Difficulty in palpating fetal parts

19. Signs & symptoms Vaginal bleeding : 78% Uterine tenderness: 66% Back pain: 60% Fetal distress: 22% Hypertonus : 17% Fetal demise: 15% 20

20. Management Revealed placental abruption If bleeding is slight : hospital admission, complete bed rest , carefull monitoring in immature foetus. A cesarean section is done once fetus reaches maturity. If bleeding is considerable : a cesarean section is done .

21. Concealed placental abruption If patient has come in shock , she is promptly resuscitated with IV fluids, blood transfusion etc. An emergency cesarean section is done as early as possible. Cesarean histerectomy

22. Pathophysiology Placental abruption initiated by hge into decidua basalis Haematoma formation In concealed type blood accumulates & seeps into myometrium Couvelaire’s uterus 23

23. Couvelaire’s uterus Also called as Utero-placental apoplexy First described by Couvelaire in early 1900 Extravasation of blood into uterine musculature & beneath uterine serosa Demonstrated only at laparotomy These myometrial hge interfere with uterine contraction to produce PPH 24

24. Couvelaire’s uterus 25

25. Complications Maternal: Maternal mortality Hypovolaemic shock Renal failure DIC PPH Rhesus sensitization Complication of massive transfusion 26

26. Complications Fetal: Fetal death Hypoxic brain injury IUGR Neonatal anemia Congenital malformations (CNS) 27

27. Diagnosis Basis of diagnosis consists of : History & physical examinations Triad of external bleeding through cervical Os, Uterine or back pain and fetal distress should be of high suspicion Defer digital cervical examinations Ultrasound – limited value but for large abruptions hypoechoic areas seen underlying placenta 28

28. Ultrasound 29

29. Ultrasound 30

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31. Laboratory tests Complete blood cell count Blood type & screen Urine analysis, Liver function tests Renal function tests Prothrombin time/ aPTT Fibrinogen levels FDP – Fibrin degradation products 32

32. Conclusion Abruptio Placentae is an important cause of fetal and maternal morbidity and mortality. The etiology is poorly understood , various management options are however available. The principle of initial assessment of the patients condition and subsequent planned management aimed at resuscitation and prolongation of pregnancy if possible or immediate delivery either for fetal or maternal indications. 33

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