Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT
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Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT made by sonal Patel
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Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT
- 2. Definition ā¢ It is one form of Antepartum Hemorrhage where the bleeding occurs due to premature separation of a normally situated placenta 2
- 3. Incidence ā¢ 0.5% - 1% of all deliveries ā¢ Decreasing trend 3
- 4. Risk factors ā¢ Increased age and parity ā¢ Preeclampsia ā¢ Chronic hypertension ā¢ Preterm ruptured membranes ā¢ Multi fetal gestation ā¢ Polyhydramnios 4
- 5. Risk factors ā¢ Cigarette smoking ā¢ Thrombophilias ā¢ Cocaine use ā¢ Prior abruption ā¢ Uterine leiomyoma ā¢ External Trauma 5
- 6. Retroplacental decidual hematoma ā¢ Separation, compression and destruction of adjacent placenta ā¢ Varieties: Concealed, Revealed & mixed ā¢ Couvelaire uterus 6 PATHOLOGY
- 7. Clinical Features Sign / symptom Frequency% Vaginal bleeding 78 Uterine tenderness back pain 66 Fetal distress 60 Preterm labor 22 Hypertonic contractions 17 Hyper tonus 17 Dead fetus 15 7
- 8. Diagnosisā¦ Essentially a clinical diagnosis ā¢Painful bleeding ā¢Abdominal findings ā¢Cardiotocographic Monitoring ā¢ AFP 8
- 10. Role of ultrasound ā limited ā¢Negative findings do not exclude the diagnosis ā¢U/S is mainly used to confirm fetal viability, Presentation & position. ā¢To exclude Placenta praevia 10
- 11. Classification Grade 0: Retrospective diagnosis. Grade 1: External bleeding present, no fetal or maternal complication Grade 2: External bleeding +/-, tense & tender uterus, Fetal distress/death Grade 3: External bleeding +/- tense & tender uterus, fetal death with maternal shock . DIC, Renal failure 11
- 12. Consumptive Coagulopathy ā¢ Delee (1901) Temporary hemophilia Parameters: Fibrinogen < 150 mg/dl, ā¢ elevated FDP, D-dimers, decrease in other coagulation factors Mechanism: DIC & retro placental clot formation ā¢ Seen in 30% cases of abruption severe enough to kill the fetus 12
- 13. Acute Renal failure ā¢ Pathology: Acute tubular necrosis (75%) & acute cortical necrosis (25%) ā¢ Mechanism: Severe hypovolemia , DIC along with Underlying preeclampsia ā¢ Prevention: Prompt & vigorous replacement of blood and circulating blood volume 13
- 14. Differential Diagnosis 1. Without pain: Placenta Previa 2. Without Bleeding: Acute degeneration or torsion of a fibroid, hematoma of rectus sheath, rupture of an appendicular abscess. 3. With mild pain & bleeding: Labour with heavy show 4. Rupture Uterus 14
- 15. Management Initial assessment ā¢ Monitor vital signs: BP ā poor guide to the extent of bleeding. ā¢ Mark the fundal height & measure abdominal girth ā¢ cardiotocographic monitoring of fetus Investigations: HB, PCV, blood grouping & typing, BT CT, Clot retraction & lyses, DIC profile ā¢ Foley catheterization & hourly output chart ā¢ watch for bleeding 15
- 16. Management āSwift & decisiveā Resuscitate the mother ā¢ Start an IV line, transfuse Ringer lactate, N Saline ā¢ Two lines if bleeding is severe ā¢ Replace blood loss and maintain circulation ā¢ Maintain PCV at 30% & urine output >30 ml/hr. ā¢ CVP in difficult cases ā¢ Delivery 16
- 17. Management Caesarian section ā¢ Live & mature fetus ā¢ Delivery not imminent ā¢ Fetal distress ā¢ No response to induction of labour ā¢ Bleeding 17
- 18. Management Vaginal delivery ā¢ Preferred if fetus is dead. ā¢ In Selected cases with a live fetus ā¢ ARM with oxytocin ā¢ Watch for PPH ā¢ RH prophylaxis 18
- 19. Management Expectant line of management ā¢ Doubtful diagnosis ā¢ Minor abruption ā¢ Preterm gestation ā¢ Intensive surveillance & Induction at or before term 19
- 20. Perinatal mortality ā¢ Main danger is to the fetus. If the abruption is severe enough to threaten the mother, the fetus will usually be dead 25 fold increase in PMR ā¢ Still birth ā¢ Prematurity ā¢ Hypoxia ā¢ Cerebral palsy 20
- 21. Maternal deaths due to hemorrhage Causes of hemorrhage Percentage Abruption 19 Uterine rupture 16 Atonic PPH 15 Coagulopathies 14 Placenta praevia 7 Uterine bleeding 6 placenta accreta/percreta 6 Retained placenta 4 21
- 22. Maternal mortality Case report: woman, who seemed well enough to wait in an emergency dept for 2 hrs. When the doctor saw her at the end of this time she was dead!!! āa fit woman may be able to compensate for severe hemorrhage until collapse occurs as a terminal eventā ā¢ A reminder ā need to maintain high standards in obstetric care 22
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