Premature separation of the normally implanted placenta (abruptio placentae)

Question 1

Investigation

Answer 1

1. Blood analysis
   - decrease platlet level
   - decrease fibrinogen level, increase fibrin split product
   - presence of schistocytes due to blood vessel damage
   - changes eg. decrease hematocrit + Hb occur later
   - every hr, drawing of venous blood sample + check for clot formation and lysis
   - failure of blood clot formation for 5 – 10 min or dissolution of clot when tube is shaken shows clotting deficiency due to low platlet + fibrinogen
2. US investigation
   - shows RP hematoma if collection ≥ 300ml
3. Cardiotocography
   - shows fetal distress
   - abdominal exam : tenderness at site, difficulty in palpating fetal parts, increase uterine size due to retroplacental heart
   - fundus height + abdominal circumference 🡪 size of enlarging RP hematoma
4. Amniotic fluid is part wine in colon

Question 2

management

Answer 2

1. mild degrees of abruption ( when fetus is immature ) + not extensive bleeding + abscent / minimum uterine irritability 🡪 no fetal distress 🡪 expectant / conservative therapy
   - obscure for 24 – 48 hrs, futher investigation to see if other condition eg. placenta praevia, anemia exist
   - maybe discharged if no futher bleeding
2. in case of signs of fetal distress + pregnancy > 36 weeks 🡪 induction of labour by oxytoxin / amniotomy + vaginal delivery
3. severe abruption
   - cerret hemodynamic state 🡪 IV infusion of colloid solution ( Roentgens ), measurement of CVP + replacement of fluids, electrolytes as needed; urinary bladder catheterization + drained and hourly measurement of volume + sp. g
   - access coagulation status + infuse clotting factors, platelet of needed
   - to prevent DIC / fluid embolism 🡪 rupture membrane artificially + release as much amniotic fluid ( AF ) as possible
   - if labour doesn’t begin 🡪 oxytocin, CTG
   - CS ?? (contra) indicate – severe fetal distress
   - immature cervix fetal alive
   - uncontrolled hemorrhage
   - if fetal is dead – vaginal

Question 3

fetal complications

Answer 3

1. fetal intrauterine hypoxia and death, exsanguination
2. preterm delivery + its complication
3. increase rate of intrauterine growth retardation, congenital abN