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
1

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
7

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
12

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
13

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 fundal height & measure
abdominal girth
• cardiotocographic monitoring of fetus
Investigations: HB, PCV, blood grouping
& typing, BT CT, Clot retraction & lyses,
DIC profile
• Foley catheterization & hourly output
chart
• watch for bleeding 15

16. Management
“Swift & decisive”
Resuscitate the 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
16

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
20

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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