abruptio placentae

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Placental Abruption:

Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital

General Consideration:

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‰

Etiology:

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

Pathology:

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 子宫胎盘卒中

Pathology:

Pathology

Manifestation:

Manifestation Vaginal bleeding companied with abdominal pain Mild type abruption≤ 1/3, apparent vaginal bleeding Severe type abruption > 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.

Adjunctive Examination:

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.

Diagnosis:

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

Diagnosis:

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

Complication:

Complication DIC Hypovolemic shock Amnionic fluid embolism Acute renal failure

Treatment:

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

Treatment:

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

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