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Placenta abruptio
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Definition
(after the 20th week or during delivery)The
separation of the placenta(in normal site)
from the site of uterine implantation before
delivery of the fetus.
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Causes Direct causes (1 to 5%).
mechanical factors such as abdominal trauma (for
example, from an auto accident or fall) sudden loss in uterine volume ( rapid loss of
amniotic fluid or the delivery of a first twin0
abnormally short umbilical cord (usually only a
problem at the time of delivery).
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Predisposing factors a past medical history of placenta abruptio (after
1 prior episode there is a 10 to 17% recurrence,
after 2 prior episodes the incidenceof recurrenceexceeds 20%)
hypertension or high blood pressure during
pregnancy is associated with 2.5 to 17.9%
incidence (however, approximately 50% of
placenta abruptio cases severe enough to cause
fetal death are associated with hypertension)
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increased maternal age
increased number of prior deliveries
increased uterine distention (as may occur withmultiple pregnancies or abnormally large volumeof amniotic fluid)
diabetes mellitus in the pregnant woman
cigarette smoking; cocaine abuse; and drinkingalcohol during pregnancy (more than 14 drinks
per week).
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Incidence The incidence of placenta abruptio,
including any amount of placental
separation prior to delivery, is about 1 out
of 150 deliveries. However, the severe
form (resulting in fetal death) occurs only
in about 1 out of 500 to 750 deliveries
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Pathologic changes Revealed abruption
Concealed abruption
Mixed type
Bloody emniotic fliud
Uteroplacental apoplexy DIC
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classification Mild type
Severe type
1/3
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Clinical findings Symptoms
Vaginal bleeding
Abdominal pain Back pain
Signs and tests
Physical examination reveals uterine tendernessand/or increased uterine tone. Hemorrhage orheavy bleeding in pregnancy may be visible orconcealed.
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Tests A CBC, may note decreased hematocrit or
hemoglobin and platelets
Prothrombin time test
Partial thromboplastin time test
Fibrinogen level test Abdominal ultrasound (may be done)
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Diagnosis Differential diagnosis
Placenta previa
Threatened rupture of uterus
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Complications
Excessive loss of blood that may lead toshockand possible fetal and/or maternal
death is the most evident complication. If
the site of placental attachment starts tohemorrhage after the delivery and loss of
blood cannot be controlled by other means,
a hysterectomy (removal of the uterus) may
become necessary.
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Chinese textbook Complications
DIC
Haemorrhagic shock
Amniotic fluid embolism
Acute renal failture
Intrauterus fetal demise
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Treatment Correct shock
Monitoring the state of fetus
Termination of the pregnancy
Correct DIC
Prevention of renal failture
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Expectations (prognosis) Maternal mortality is uncommon: range from 0.5to 5%. Early diagnosis of the condition andadequate intervention should decrease the
maternal death rate to 0.5 to 1%. Fetal death rates range from 20-35 %. Upon
hospital admission, no fetal heart tone isdetectable in about 15% of cases. Fetal distress
appears early in the condition in approximately50% of cases. The infants who live have a 40 to50% incidence of illness.
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Concealed vaginal bleeding in pregnancy,
excessive loss of blood resulting in shock,
absence of labor, a closed cervix, and
delayed diagnosis and treatment are
unfavorable factors that may increase the
risk of maternal or fetal death.
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