Abruptio Placentae




Abruptio Placentae
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.



READ MORE:

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Croup and Epiglottitis



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