Placental Abruption

Liu WeiDepartment 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 factors1. Increased age and parity2. Vascular diseases: preeclampsia, chronic

hypertension, renal disease.3. Mechanical factors: trauma, intercourse,

polyhydramnios, 4. Supine hypotensive syndrome5. 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• Ultrasonography1. Position of placenta, severity of abruption,

survival of fetus2. Signs: retroplacental hematoma3. Negative findings do not exclude placental

abruption• Laboratory examination1. consumptive coagulopathy: Rt, DIC2. Function of liver and kidney.

Diagnosis• sign and symptom1. Vaginal bleeding2. Uterine tenderness or back pain3. Fetal distress4. High frequency contractions5. Hypertonus6. Idiopathic preterm labor7. Dead fetus

Diagnosis• Ultrasonography• Differential diagnosis1. Placenta previa Painless bleeding2. 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 coagulopathy1. Supplement of coagulation factors: fresh

blood, frozen blood plasma, fibrinogen, blood platelet.

2. Heparin: high coagulation3. Anti-fibrinolysis• Prevention of renal failure

END