Placental Abruption

Liu Wei
Department of Ob & Gy
Ren Ji hospital
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
Uncertain (primary cause)
Risk factors
1. Increased age and parity
2. Vascular diseases: preeclampsia, chronic
hypertension, renal disease.
3. Mechanical factors: trauma, intercourse,
polyhydramnios,
4. Supine hypotensive syndrome
5. Smoking, cocaine use, uterine myoma
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
Pathology



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
Ultrasonography
1. Position of placenta, severity of abruption,
survival of fetus
2. Signs: retroplacental hematoma
3. Negative findings do not exclude placental
abruption
Laboratory examination
1. consumptive coagulopathy: Rt, DIC
2. Function of liver and kidney.
Diagnosis
sign and symptom
1. Vaginal bleeding
2. Uterine tenderness or back pain
3. Fetal distress
4. High frequency contractions
5. Hypertonus
6. Idiopathic preterm labor
7. Dead fetus
Diagnosis
Ultrasonography
Differential diagnosis
1. Placenta previa
Painless bleeding
2. Pre-rupture of uterus
dystocia
Complication
DIC
Hypovolemic shock
Amnionic fluid embolism
Acute renal failure
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 of consumptive coagulopathy
1. Supplement of coagulation factors: fresh
blood, frozen blood plasma, fibrinogen, blood
platelet.
2. Heparin: high coagulation
3. Anti-fibrinolysis
Prevention of renal failure
END