A placental abruption: - PowerPoint PPT Presentation

Loading...

PPT – A placental abruption: PowerPoint presentation | free to download - id: 7366e4-ZjJlY



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

A placental abruption:

Description:

A placental abruption: - pre-mature separation of normally situated placenta after 22 weeks of pregnancy. - etiology unclear - associated factors. – PowerPoint PPT presentation

Number of Views:141
Avg rating:3.0/5.0
Slides: 26
Provided by: A752
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: A placental abruption:


1
  • A placental abruption
  •  
  • - pre-mature separation of normally situated
    placenta after 22 weeks of pregnancy.
  • - etiology unclear

2
- associated factors.
  • sever pre-eclampsia, not chronic HTN.
  • 2. after delivery of 1st twins ,and occurrence
    ROM .
  • 3. direct trauma to the abdomen RTA.
  • 4. seat belt injury
  • 5. violence.
  • 6. previous c.s
  • 7. High parity.
  • 8. cigarette smoking.
  • 9. ECV.
  • - incidence 0.4-1.8

3
partial separation
  • - bleeding from maternal venous sinus.
  • apparent bleeding from vaginal due to .
  • retained bleeding behind placenta and forced
    into the myometrium, and infiltrate between
    muscle fibers bruised, edematous uterus
  • -couvelaire uterus
  • -uterine apoplexy

4
  • -clp
  • -no vaginal bleeding.
  • -Signs of hypovolemic shock (concealed Hge )
  • uterine enlargement.
  • Extreme pain.

5
  • 3) Mixed Hge
  • - bleeding per vagina.
  • - concealed Hge. In the uterine muscle.
  • - revealed , concealed , mixed.

6
  • according to mother and baby condition
  • mild
  • moderate.
  • sever Hge.
  • assessing mother condition.

7
  • Hx pre eclampsia.\recent hx of N ,V headache ,
    blurred vision.
  • Physical domestic violence appear .
  • ECV - RTA.
  • Delivery of first twins
  • Loss of copious amount of amniotic fluid .
  • Slight localize pain revealed.
  • - concealed (sever abd. pain.)

8
General examination
  • Anxious , abd pain, pallor
  • edema of the face, fingers, pretibial area.
  • Alteration of v/s, except Bp in case of PIH
  • Respiration pulse within normal.
  • Temp. normal air hunger
  • if sever infection developed fever.
  • Brown dark blood .
  • Fresh bright.

9
  • Abd examination.
  • More than expected gestational age concealed .
  • Hard uterus.
  • Rigid uterus, painful.
  • Gaurading on palpation of abdomen
  • Us CTG
  • Fetal death is common out come

10
  • assessing fetal condition
  • -fetal movement
  • -CTG
  • -U\s

11
  • management
  • I Vcanula , CBC , blood group , cross match
    ,clotting factors.
  • psychological care.
  • analgesic for pain morphine 15 mg , pethidine
    100-150mg.
  • differentiate between pain from concealed
    hemorrhage, or pain from uterine contraction.

12
source of pain
  • bleeding between muscle and membrane of placenta
  • labor pain
  • sub capsular hemorrhage ( pre -eclampsia)
  • management of shock (hypovolemic shock
    ,hemorrhagic
  • plasma or blood transfusion
  • haemacele -doesn't alter platelet functions
    ,improve renal function
  • position left side ,sever shock elevate legs
    ,semi recumbent position

13
-midwifery role
  • Resuscitate mother before surgery
  • Check v\s regularly
  • Cvp
  • Canula in place
  • Io recorded by indwelling catheter
  • Urinanalysis for proteinuria
  • Fluid requirement should record
  • Fundal height checked regularly
  • Continuous CTG if baby living
  • Anti D for mother RH ve

14
management of different degree of placental
abruption
  • 1-mild (incidental )
  • Mild separation of placenta ( partial )
  • Slight vaginal bleeding
  • Mother fetus in stable condition

15
  • -no signs of shock
  • -abdomen lax
  • -soft uterus
  • -??pp
  • Dx u/s
  • Rxu/s
  • -v/s
  • -fetal condition monitoring by CTG
  • -if mother not in labor ,lt 37 weeks follow up
  • -gt37 weeks IOL

16
  • IOLdone in case of
  • 1-mild episode of bleeding
  • 2-no evidence of fetal compromise
  • Nb anemic mother with mild abruption placenta
    need more concern

17
Moderate
  • Separation of placenta 1\4
  • -vaginal bleeding
  • -formation of retro placental blood clot
  • C/p
  • -uterine tenderness
  • -increase pulse rate
  • -decrease blood pressure
  • -hypoxic baby
  • -IUFD

18
  • Management
  • -manage shock
  • -analgesic
  • -fluid blood transfusion
  • -cvp monitoring
  • -continuous CTG
  • -vaginal birth contracted stop bleeding after
    birth
  • -psychological support
  • augmentation of labor 1-amniotomy ROM
  • 2-oxytocin infusion

19
- sever type
  • -acute emergency condition
  • -detachment of placenta 2\3
  • -life threatening condition
  • -most of blood concealed
  • -sever shock decrease blood pressure ,if normal
    suspect pre-eclampsia cases
  • -fetus almost died
  • -sever abdominal pain
  • -board like abdomen

20
Complications
  • DIC -RF
  • Pituitary dysfunction
  • -The same as moderate treated by blood
    transfusion, cs delivery in case of sever
    bleeding
  • cvp
  • pain relief

21
  • Care of the baby
  • Asphyxia (pediatrician, equipment well prepared)
  • may need neonatal ICU
  • physical care
  • full information and explanation to the family.

22
  • Partner support.
  • If baby go neonatal ICU "visit her"
  • Let mother to handle her baby before going to
    nursery.
  • N.B abruption placenta has a risk factor for
    recurrence in the next pregnancy.

23
Complications
  • DIC is a complication of moderate to severe
    placental abruption.
  • Postpartum hemorrhage may occur as a result of
    the Couvelaire uterus and disseminated
    intravascular coagulation, or both. Intravenous
    ergometrine 0.5 mg is given at birth as a
    prophylactic measure.
  • Renal failure may occur as a result of
    hypovolaemia and consequent poor perfusion of the
    kidneys.

24
  • Pituitary necrosis is another possible
    consequence of prolonged and severe hypotension
    (also known as Sheehan's syndrome see medical
    texts for details of this rare condition).
  • The maternal mortality rate due to placental
    abruption is 1

25
???? ???? ????????
About PowerShow.com