35. Placental abruption. Flashcards
what is placental abruption
antepartum hemorrhage where the bleeding occurs due to premature separation of normally situated placenta
what are the risk factors for placental abruption ?
any types of hypertension in pregnancy
Multiple pregnancy - 5 or more gravida
advancing age
smoking
trauma- external cephalic version
amniocentesis
short cord
folic acid def
when does placental abruption commonly occur?
25th week of gestation
what are the varieties of placental abruption ?
revealed - following separation of placenta - blood runs down between membrane and decius - coming out of cervical canal
MOST COMMON
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concealed
blood collected behind the separated placenta or between membrane and decidua
prevented from showing by the presenting part which presses on lower segment
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mixed - conceleaedu and revealed = common
what is couvelaire uterus ?
severe form of concealed abruptio placentae. bleeding into the uterine musculature up to the serous coat forcing it’s wa to the peritoneum. The condition can only be diagnosed on laparotomy.
uterus is of dark port wine color which may be patchy or diffuse. It tends to occur initially on the cornu before spreading to other areas, more specially over the placental site
signs and symptoms of placental abruption
in revealed : abdominal pain vaginal bleeding uterine tenderness non stopping frequent contractions fetal parts easy to palpate
in mixed : SUDDEN localised abdominal pain followed by slight vaginal bleeding uterus is tense , tender and rigid UTERINE IN ENLARGENED AND GLOBULAR fetal parts difficult to palpate - FHS ABSENT urine output diminished
blood is continuous dark color
dangerously low blood pressure - shock
what is a big complication to the mother from placental abruption
fibrin clots in hepatic sinusoids
DIC and
kidney failure - acute cortical or tubular necrosis
what is a big complication of the baby to this ?
fetal distress low birth weight preterm delivery Fetal asphyxia still birth
how is placental abruption diagnosed
ultrasound not diagnostic for placental abruption
rising fundus monitored and diagnosis is mainly clinical
in concealed - hock out of proportion to external bleeding, (ii) unexplained extreme pallor, (iii) presence of preeclamptic features,
class 0 - asymptomatic , diagnosis is made due to blood clot in delivered placenta
class 1- no/ minimal vaginal bleeding
normal bp
no coagulopathy
no fetal distress
class 2 - moderate vaginal bleeding
maternal tachycardia with orthostatic changes in bp and heart rate
fetal distress
hypofibrinogenima
class 3 - heavy vaginal bleeding very painful titanic uterus maternal shock hypofirbinogenima coagulopathy fetal death
using MRI has very high sensitivity to placental abruption
how is placental abruption mamaged clinically ?
small abruption grade 1 - bed rest
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more severe and near term - grade 2 or more
Ringer’s solution drip is started
blood transfusion
urinary catheter
rh isoimmunisation - within 72 hours of the onset of bleeding
giving the mother extra oxygen before delivery - to prevent asphyxia
delivery -
limited placental abruption FHR tracing is reassuring
and mother is stable
then vaginal delivery
if not c section - Regional anesthesia is generally avoided when there is significant hemorrhage. This is to avoid profound and persistent hypotension
vaginal delivery is preferred because of DIC
Induction of labor is done by low rupture of membranes. Oxytocin may be added to expedite delivery.
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less than 36 weeks-
if non reassuring fetal status and unstable mother - c section delivery
stable fetal stats and mother close monitoring corticosteroid given to mature the baby's lungs IV ringers solution rh d
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after delivery 7 days monitoring for post partum haemorrhage
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may require
fresh frozen plasma for hypofibrinogenemia
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if excessive bleeding - c section and emergency hysterectomy or oxytocin for contraction of uterus with blood transfusion
what determines if the placental abruption is server or not
caused by arterial bleeding at the center of the placenta leads to sudden development of severe symptoms and life-threatening conditions : including fetal heart rate abnormalities,
Those abruptions caused by venous bleeding at the periphery of the placenta develop more slowly and cause small amounts of bleeding, intrauterine growth restriction, and oligohydramnios
what is avoided when there is significant hemorrhage ?
regional anaesthesia in c section to avoided because it can cause HYPOTENSION
