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Placental Abruption

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The separation of the placenta from its site of implantation ... dystocia. Complication. DIC. Hypovolemic shock. Amnionic fluid embolism. Acute renal failure ... – PowerPoint PPT presentation

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Title: Placental Abruption


1
Placental Abruption
  • Liu Wei
  • Department of Ob Gy
  • Ren Ji hospital

2
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

3
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

4
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 ??????

5
Pathology
6
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7
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8
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.

9
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.

10
Diagnosis
  • sign and symptom
  • Vaginal bleeding
  • Uterine tenderness or back pain
  • Fetal distress
  • High frequency contractions
  • Hypertonus
  • Idiopathic preterm labor
  • Dead fetus

11
Diagnosis
  • Ultrasonography
  • Differential diagnosis
  • Placenta previa
  • Painless bleeding
  • Pre-rupture of uterus
  • dystocia

12
Complication
  • DIC
  • Hypovolemic shock
  • Amnionic fluid embolism
  • Acute renal failure

13
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

14
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

15
END
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