Abruptio Placenta

A) Definition-

1) Bleeding occurs due to premature separation of normally situated placenta.

2) Bleeding is always maternal.

3) Placental tears may cause fetal bleeding.

B) Varieties-

1) Revealed-

a) Blood comes out of cervical canal.

b) Most common type.

2) Concealed-

a) Coming out of blood prevented by presenting part.

b) Blood gets collected in between the membranes and decidua.

c) Blood may percolate into amniotic sac after rupturing the membrane.

d) This type is rare.

3) Mixed-

a) Some blood collects inside and some part is expelled out.

b) One variety predominates over other.

c) Quite common.

C) Etiology(IF THUS MAP)

1) Implantation over fibroid.

2) Folic acid deficiency.

3) Trauma, Torsion of uterus.

4) High birth order pregnancies.

5) Uterine decompression.

6) Short cord, Smoking.

7) Malnutrition.

8) Advancing age of mother.

9) Placental anomaly.

D) Pathogenesis-

1) Depending upon etiological factors, premature placental separation is initiated by hemorrhage.

2) At early phase decidual hematoma hardly produce any morbid pathological changes.

3) Depending upon the severity, changes in the spiral arteries leads to degeneration, infarction and necrosis of decidua basalis as well as placenta adjacent to it.

4) Absence of rhythmic uterine contraction plays significant role for blood to remain concealed.

5) Decidual heamtoma is visible only after the expulsion of placenta.

6) The feature of retroplacental hematoma-

a) Depression found on maternal surface of placenta with clot which may found firmly attached to area.

b) Areas of infarction with varying degrees of organization.

E) Changes in other organ-

1) Liver-

- Presence of hepatic knots in hepatic sinusoids.

2) Kidneys-

- Acute corticol necrosis.

- Acute tubular necrosis.

F) Clinical Classification-

1) Grade 0-

a) Clinical features may absent.

2) Grade 1 (40%)-

a) Vagina; Slight bleeding.

b) Uterus; Irritable with minimal tenderness.

3) Grade 2 (45%)-

a) Vaginal bleeding mild to moderate.

b) Uterine tenderness.

c) High pulse.

d) Low fibrinogen level.

e) Fetal death may occur.

4) Grade 3 (15%)-

a) Bleeding moderate to severe.

b) Marked uterine tenderness.

c) Fetal death.

G) Clinical features-(PUS HAL)

- Depends upon-

a) Degree of seperation.

b) Speed at which separation occurs.

c) Amount of blood concealed inside.

1) Pre-eclampsia.

2) Uterine tenderness.

3) Shock.

4) Hemorrhage.

5) Abdominal pain.

6) Low Hb.

H) Complications-

1) Revealed-

a) Maternal-

i) Proportionate blood loss.

b) Fetal-

ii) Fetal death 25- 30%.

2) Concealed-

a) Maternal-

i) Hemorrhage.

ii) Shock.

iii) Blood coagulation disorders.

iv) Oliguria and anuria.

v) Postpartum hemorrhage.

vi) Pueperal sepsis.

b) Fetal-

i) Fetal death 50 - 100%.

I) Management-

1) Prevention-

a) Elimination of known factors.

b) Correction of anemia to withstand the blood loss.

2) Treatment-

a) Assessment of-

i) Amount of blood loss.

ii) Maturity of fetus.

iii) Whether the patient is in labour.

iv) Presence of any complication type and grade of abruption.

b) In hospital-

i) Immediate delivery.

ii) If the patient is in labour delivery is favoured.

iii) If the patient is not in labour and bleeding continues then delivery either by induction or LSCS.

iv) Vaginal delivery is favoured in cases with-

- Limited placental abruption.

- Facilities for continue fetal monitoring.

- Placental abruption with dead fetus.

A) Revealed and B) Conceal Abruptio Placenta

Placenta Previa Complication

Placenta Previa Complication