Placenta Abruption (abruptio placentae)

Slides:



Advertisements
Similar presentations
Complications of Pregnancy Author: Evelyn M. Hickson, RN, MSN, CNS, WCC.
Advertisements

Bleeding in Early and Late Pregnancy
Obstetric Hemorrhage Abike James MD Assistant Clinical Prof. Obstetrics and Gynecology University of Pennsylvania.
Ante partum hemorrhage : Islamic University of Gaza faculty of Nursing.
Vaginal Bleeding in Late Pregnancy
* Antipartum hemorrhage : -affects 3-5 % of pregnancies -bleeding from or into the genital tract Occurring from 20 weeks of pregnancy and prior to the.
Indications for Obstetrical Ultrasound Examinations
Antepartum Haemorrhage
Obstetric Hemorrhage Anne McConville, MD
Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital.
ANTEPARTUM HAEMORRHAGE
ANTEPARTUM HAEMORRHAGE. Obstetric Haemorrhage  Ranks as the First cause of maternal mortality accounting for 25 – 50 % of maternal deaths.
Associate Professor Iolanda Elena Blidaru Md, PhD.
8/2/ Mrs. Mahdia Samaha Kony. 8/2/ Mrs. Mahdia Samaha Kony.
Hai Ho, MD Department of Family Practice
Antepartum Hemorrhage (APH)
Rupture of uterus Ob & Gy Department, First Hospital, Xi’an Jiao Tong University SHU WANG.
With one woman dying during pregnancy or complications of childbirth every minute of every day, and 3.6 million neonatal deaths per year, maternal and.
Preventing Elective Deliveries Before 39 Weeks John R. Allbert Charlotte, NC.
Amniotic Fluid Problems. Amniotic fluid is an important part of pregnancy and fetal development. This watery fluid is inside a casing called the amniotic.
In normal pregnancy, the cervix remain closed and retains the product of conception with in uterus. In normal pregnancy, the cervix remain closed.
8th Edition APGO Objectives for Medical Students
Vaginal Bleeding in Late Pregnancy
Antepartum Haemorrhage (APH)
Diseases and Conditions of Pregnancy pre-eclampsia once called toxemia –a pregnancy disease in which symptoms are –hypertension –protein in the urine –Swelling.
If you are a doctor In the midnight, the pregnant women awakens to find that they have to sleep in a pool of blood.
MULTIPLE PREGNANCY King Khalid University Hospital Department of Obstetrics & Gynecology Course 482.
Antepartum Hemorrhage (APH)
Antepartum Haemorrhage and Postpartum Haemorrhage
Breech presentation occurs in about 2 to 4 % of singelton deliveries at term and more frequently in the early third and second trimester.
Zareh.F.MD. All bleeding during pregnancy should be investigated by examination and imaging studies.
Placenta previa Placental abruption
Preterm labor.
Adam Fogel, Christopher Elliot, Miso Gostimir
ANTEPARTUM HAEMORRHAGE
POST TERM PREGNANCY & IOL Dr. Salwa Neyazi Assistant professor and consultant OBGYN KSU Pediatric and adolescent gynecologist.
Complication o Labor. Psychologic Disorders Alterations in thinking, mood or behavior Keep her well oriented and promote optimal functioning in labor.
Max Brinsmead MB BS PhD May Definition and Incidence  Prolonged pregnancy is defined as that proceeding beyond 42 weeks gestation  In the absence.
Placenta Previa Liu Wei Department of Ob & Gy Ren Ji hospital.
THIRD TRIMESTER BLEEDING Rukset Attar, MD, PhD Department of Obstetrics and Gynecology.
ASSOCIATE PROFESSOR IOLANDA BLIDARU MD, PhD.
ANTE-PARTUM HAEMORRAGE (APH)
A BORTION & C ARE OF A BORTED F ETUS. OBJECTIVES Definitions.
Antepartum Hemorrhage Family Medicine Specialist CME University of Health Sciences.
PLACENTA PREVIA Lin Qi De. Definition Placenta previa: Abnormal location of the placenta over,or in close proximity to the internal os. Incidence: approximately.
1 Clinical aspects of Maternal and Child nursing NUR 363 Lecture 4 Intrapartum complications.
SMFM Clinical Consult Series
Khanpur Kalan(Sonepat)
Ghadeer Al-Shaikh, MD, FRCSC Assistant Professor & Consultant Obstetrics & Gynecology Urogynecology & Pelvic Reconstructive Surgery Department of Obstetrics.
A placental abruption: - pre-mature separation of normally situated placenta after 22 weeks of pregnancy. - etiology unclear.
1 Clinical aspects of Maternal and Child nursing Intrapartum complications.
Chapter 33 :Midwifery and obstetric emergencies. Vasa praevia -The term vasa praevia is used when a fetal blood vessel lies over the os, in front of the.
Obstetrical Emergency: Placental Abruption Kelsie Kelly, MD, MPH University of Kansas Department of Family Medicine Partially supported.
Vasa Praevia Dr Fatima Z Ashrafi DGO (Dub), FRCS (Edin), MRCOG (Lon), FRANZCOG Gisborne Hospital, New Zealand.
BREECH PRESENTATION Lecturer: Dr. Hui Wang Department of Obstetrics & Gynaecology Tongji Hospital Tongji Medical College Huazhong University of Science.
Antepartum Hemorrhage PPT
VASAPREVIA and VELAMENTOUS PLACENTA
Obstetrical emergencies
Liu Wei Department of Ob & Gy Ren Ji hospital
PLACENTA PREVIA.
Placenta Previa Abruptio Placenta.
Bleeding in Pregnancy:
Antepartum haemorrhage
THIRD TRIMESTER BLEEDING
Placental abruption (accidental hemorrhage
Placenta Previa Abruptio Placenta.
Ante-partum Hemorrhage
Pregnancy at Risk: Gestational Conditions
Presentation transcript:

Placenta Abruption (abruptio placentae)

Concealed and revealed hemorrhage . Definition: bleeding at the decidual-palacental interface that causes partial or total placental detachment prior to delivery of the fetus over 24 weeks of gestation Types: Concealed and revealed hemorrhage .

Incidence: 0.4%-1% of pregnancies 40-70% occurs before 37 weeks . Severe abruption can kill fetus 1 in 1600 births. It is a significant cause of maternal morbidity and perinatal morbidity and mortality (Pnmortality :12% and 77% occurs in utero ) PNm Rate : the number of stillbirths and deaths in the first week of life per 1000 live birth.

Risk factors: 1-Abdominal trauma / accidents 2-cocain or other drug abuse( hypertension,vasoconstriction of placental b.v) 3-Poly hydramnios 4-hypertensive disease during pregnancy (3-4 fold increase) 5-premature rupture of membranes , incidence: 5% 6-chorioamnionitis , I uGR 7- previous abruptio: recurrence 5-15% Third rises the incidence 20-25% 8- with increasing age, parity and moking 9-uterine anomalies , leiomyoma, uterine synchiae 10-first trimester bleeding 11-thrombophilia :inherited factor V Leiden Acquired : APL.syndrome

Clinical presentation: -vaginal bleeding (mild,moderate or severe) -Abdominal pain or back pain ( if posterior placenta) -DIC occurs in 10-20% of severe abruption and death of fetus(severe if placenta separate >50%) B.P ,FH abnormalities or death Tender or rigid or firm abdomen (woody feel) Hypertonic uterine contractions DIC Hypovolemic shock , renal failure , ARDS multiorgan failure Hysterectomy, blood transfusion,rarely death Couvelaire uterus

Fetal & neonatal outcome: Increased mortality and morbidity due asphyxia , IUGR, hypoxemia, and preterm delivery. -Recurrence: Several – fold higher risk of abruption in subsequent pregnancy= 5-15% Risk of third rises 20-25% Management: depends on condition of the mother , fetus and gestational age . Chronic abruption: light, chronic, intermittent bleeding , oligohydroamnious , IUGR, pre-ecclampsia , preterm ro.m Coag.studies usually normal .

Placenta previa Definition: the presence of placental tissue that extends over or lies proximate to the internal cervical os. (beyond 24 weeks of gestation ) Degrees: 1-total or complete placenta previa: the placenta completely covers the internal os 2-partial previa : the placenta partially covers the I.O 3-marginal previa : the edge of the placenta extends to the margin of the I.O 4-low-lying placenta : placental margin is within 2cm of I.O

Presentation: -painless , recurrent vaginal bleeding in 70-80% -uterine contractions in 10-20% Prevalence : 3.5-4.6/1000 births Recurrence : 4-8% Risk factors: -previous c/s, placenta previa -multiple gestation, multiparity , advanced maternal age. -infertility treatment , previous abortion -previous intrauterine surgical procedures -maternal smoking , cocaine use -non white race , male fetus

Associated conditions : Placenta accreta : complicated 1-5% patients with placenta previa . If previous c/s : 11-25% Two c/s : 35-47% Three c/s : 40% Four c/s : 50-67% Preterm labor , rupture of membrane , mal presentation ,IUGR, vasa previa , congenital anomalies , amniotic fluid embolism .

Diagnosis : Soft abdomen , normal fetal heart , mal presentation -avoid vaginal ,rectal examination or sexual intercourse Investigation: 1-abdominal u/s : false +ve 25% due to over distended bladder or uterine contractions , or can be missed if fetal head is low in pelvis 2-transvaginal u/s : (if diagnosis by abdominal u/s not certain) , or trans perineal u/s 3-MRI : High cost

Management : Treatment depends on gestational age , amount of vaginal bleeding , maternal status and fetal condition . Expectant management : If fetus is preterm less than 37 weeks : -hospitalization -investigations ( cbc , rft , lft , coagulation factors , blood grouping and rh ) Steroids (between 24-34 weeks ) antiD ig if the mother is rh negative -cross match blood and blood products . -CTG -elective c/s : if fetus more than 37 weeks -emergency c/s : if severe bleeding or fetal distress

Morbidity and mortality : -hemorrhage -hypovolemic shock (renal.f , shehan’s syndrome, death) -blood transfusion risk -hysterectomy , uterine/iliac A ligation or embolization of pelvic vessels Increase mmR Increase neonatal morbidity .

-fetal BV cross or run near the cervix. Vasa previa : 1:2000 -fetal BV cross or run near the cervix. -rare but very serious cause of vaginal bleeding -bleeding is fetal in origin associated with velamentous cord insertion where fetal blood vessels in the membranes cross the cervix . Rupture of membranes can lead to tearing of fetal B.V with exsanguination of the fetus . Tests are often not applicable . Diagnosis by color flow doppler ultrasound Risk factors: -velamentous insertion: not every pregnancy with velamentous insertion results in vasa previa, only when BV near the cervix. -Bi-lobed or succenturiate lobed placenta -multiple pregnancy -low lying placenta -IVF pregnancy Normal placenta