Abruptio Placentae
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| Abruptio Placentae |
Premature separation of the normally implanted Placentae. separation occurs in the area of decidua basalis, most often in the 3rd trimester, but can happen any time after 20 weeks.
Incidence:
Complicates approximately 1% of pregnancies.Is a serious disorder, accounts for about 15 % of all perinatal mortality " most common cause of intrapartum fetal death ".
Permanent neurologic impairment in 14% of surviving infants.
Classification:
The 3 types of Abruptio Placentae are:1- Covert: Placentae separates in the centre and the bleeding is concealed.
2- Overt: blood pass from under the Placentae causing vaginal bleeding.
3- Placentae prolapse: total separation of Placentae with massive bleeding.
Aetiology:
Maternal hypertension.PIH.
Cocaine-induced.
Maternal smoking.
Short umbilical cord.
Uterine anomalies.
Poor nutrition.
Physical work.
Trauma.
Amniotomy in patients with polyhydramnios.
Recurrent Risk:
- Tenfold increase in second pregnancy overpopulation risk.- With 2 previous abruptions 25% chance of the third abruption.
Clinical manifestation:
- Vaginal bleeding (80% of the patient), blood remains concealed (20% of patients).- Sudden onset of severe continuous abdominal pain and/or low back pain.
- Uterine contraction with a rigid, tender and irritable uterus.
- Amniotic fluid colour may be dark red.
- If bleeding is severe, hypofibrinogenemia may develop ( consumptive coagulopathy).
Fetal activity may be increased, because of fatal hypoxia . with severe complete abruption fetal heart tones may not be heard.
Complication: " accompany moderate to severe abruption "
1- hypovolemic shock.- Pituitary necrosis ( Sheehan Syndrome).
- Renal failure.
Aetiology: is unclear, probably from reduced renal perfusion.
2- Fetal hypoxia or anoxia with possible fetal death.
3- Consumptive coagulopathy hypofibrinogenemia DIC.
4- Covelair uterus: bleeding into the myometrium resulting in broad like the rigidity of the uterus.
5- Hepatitis post blood or fibrinogen transfusion.
Management:
1- maternal urine greater than 30ml/ hr.2- HCT greater than 30 %.
3- induction of labour.
4- cesarean section: if
- Continued bleeding.
- Fetal distress.
- Maybe dangerous is the setting of coagulation defect.
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