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 子宫胎盘卒中

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

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