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ABRUPTIO PLACENTAE

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  • premature separation of a normally implanted placenta after 20 weeks OF gestation 
  • incidence = 0.5-1.5%
   

Classification

  1. total (fetal death inevitable) vs. partial
  2. external/revealed/apparent; blood dissects downward toward cervix
  3. Internal/concealed (20%); blood dissects upward toward fetus
  4. most are mixed
Etiology

unknown, but associated with
  1. maternal hypertension (chronic or PIH) in 50% of abruptions
  2. multiparity
  3. previous abruption (recurrence rate 10%)
  4. PROM
  5. maternal age > 35 (felt to reflect parity)
  6. maternal vascular disease
  7. cigarette smoking
  8. alcohol consumption
  9. uterine distension (polyhydramnios, multiple gestation)
  10. short cord
  11. trauma
  12. Sudden decompression of the uterus (twins)
  13. uterine anomaly, fibroids
Fetal Complications

  1. perinatal mortality 25-60%
  2. prematurity
  3. intrauterine hypoxia
Maternal Complications

  1. < 1% maternal mortality
  2. DIC (in 20% of abruptions)
  3. acute renal failure
  4. anemia hemorrhagic shock
  5. pituitary necrosis (Sheehan syndrome)
  6. amniotic fluid embolus
Clinical Features 

  1. PAINFUL vaginal bleeding; blood may be bright red or dark or clotted 
  2. uterine tenderness and increased tone
  3. degree of anemia may not correlate with degree of observed blood loss 
  4. fetal distress; loss of variability, late decelerations
  5. 15% present with fetal demise
Diagnosis

  • clinical
  • U/S NOT helpful except to rule out placenta previa
Management

Initial management
  1. maternal stabilization, IV hydration
  2. fetal monitoring
  3. monitor maternal vitals, urine output
  4. blood for hemoglobin, platelets, PT/PTT, fibrinogen, FDP, cross and type
  5. blood products on hand (red cells, platelets, cryoprecipitate) because of DIC risk
  6. Rhogam if Rh negative

Mild abruption and GA < 36 weeks
  1. close observation of fetal well-being and amount of bleeding
  2. limited physical activity
  3. serial Hct to assess concealed bleeding
  4. delivery when fetus is mature or when hemorrhage dictates

Mild abruption and GA > 36 weeks
  1. stabilization and delivery
Moderate to severe abruption
  1. hydrate and restore blood loss and correct coagulation defect if present
  2. vaginal delivery if no evidence of fetal or maternal distress and if cephalic presentation OR with dead fetus
  3. labour must progress actively

Severe abruption and live fetus
  1. C-section if fetal or maternal distress develops with fluid/blood replacement, labour fails to progress or non-cephalic fetal presentation
ABRUPTIO PLACENTAE ABRUPTIO PLACENTAE Reviewed by Radiology Madeeasy on October 07, 2010 Rating: 5
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