Placental Abruption

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Placental Abruption

• Liu Wei
• Department of Ob Gy
• Ren Ji hospital

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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

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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

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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 ??????

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Pathology
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Manifestation

• Vaginal bleeding companied with abdominal pain
• Mild type
• abruption 1/3, apparent vaginal bleeding
• Severe type
• abruption gt 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.

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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.

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Diagnosis

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

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Diagnosis

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

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Complication

• DIC
• Hypovolemic shock
• Amnionic fluid embolism
• Acute renal failure

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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

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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

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END