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ABRUPTIO PLACENTA

ABRUPTIO PLACENTA. ANTEPARTUM HEMORRHAGE DEFINITION. Bleeding from or into the genital tract after the 28 th weeks of gestation but before the birth of the baby. - D C. Dutta. CAUSES OF ANTEPARTUM HAEMORRHAGE. PLACENTAL BLEEDING Placenta previa

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ABRUPTIO PLACENTA

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  1. ABRUPTIO PLACENTA

  2. ANTEPARTUM HEMORRHAGE DEFINITION Bleeding from or into the genital tract after the 28th weeks of gestation but before the birth of the baby. - D C. Dutta.

  3. CAUSES OF ANTEPARTUM HAEMORRHAGE • PLACENTAL BLEEDING • Placenta previa • Abruptio placenta • UNEXPLAINED • EXTRA PLACENTAL CAUSES • Local cervico-vaginal lesions • Cervical polyp • Carcinoma cervix • Varicose vein • Local trauma

  4. ABRUPTIO PLACENTAE A latin word “Abruptio placentae” means “Rending asunder of placenta”, which means ‘a sudden accident’

  5. DEFINITION Bleeding occurs due to premature separation of normally situated placenta after 28 weeks of gestation and before the birth of the baby. - Williams.

  6. INCIDENCE • 1 in 150 deliveries which resulted death of fetus • 1 out of 500-750 deliveries lead to maternal mortality about 2-5%

  7. ALTERNATIVE NAMES • Premature separation of placenta • Accidental haemorrhage • Ablatioplacentae • Abruptio placentae • Placental abruption

  8. TYPES • REVEALED • CONCEALED • MIXED

  9. ETIOLOGY PREVALANCE IS MORE WITH • High birth order • Advancing age of mother • Poor socio-economic condition • Malnutrition • Smocking

  10. ETIOLOGY.....Contd • Hypertension in pregnancy • Trauma • Sudden decompression • Short cord • Supine hypotensive syndrome • Placental anomaly

  11. ETIOLOGY.....Contd • Sick placenta • Folic acid deficiency • Uterine factor • Torsion of the uterus • Cocaine abuse • Thrombophilias • Prior abruption

  12. PATHOGENESIS • Due to etiology Hemorrhage into decidua basalis Decidua splits Development of decidual hematoma Separation, compression, ultimate destruction of placenta.

  13. Contd… 2. Decidual spiral artery ruptures Retroplacental hematoma forms Expands with increase in bleeding. Area of separation rapidly becomes extensive & reach margins Uterus unable to contract & compress vessels Blood dissect membranes from uterine wall

  14. CLINICAL FEATURES

  15. CLINICAL FEATURES……Contd

  16. CLINICAL FEATURES……Contd

  17. CLINICAL CLASSIFICATION: • Grade 0 • Clinical features absent • Grade I • Bleeding slight • tender and irritable uterus • Maternal Bp and fibrinogen level unaffected • FHS good. • Grade II • Bleeding moderate • uterus tender • shock absent • fetal distress present. • Grade III • Bleeding severe • uterus tender • shock present • fetal death is ruled • coagulation defect or anuria.

  18. MANAGEMENT PREVENTION: Aims - >Eliminate risk factors >Correct anemia >Prompt detection & treatment >Avoid trauma >Avoid sudden decompression of uterus >Avoid supine hypotension >Routine Folic acid administration

  19. -Rush to well equipped maternity unit as early as possible……… Treatment: AT HOME:

  20. IN HOSPITAL:

  21. I. REVEALED TYPE: • Assessment of case • Assess amount of blood loss • Assess maturity of fetus • Assess whether in labour or not • Presence of any complication

  22. Preliminaries • Sent blood for Hb%, coagulation profile, ABO, Rh grouping. • Urine for protein. • Ringer’s solution drip & arrange for blood transfusion. • Close monitoring of mother & fetus *Use Large Bore IV Lines*

  23. Definitive Treatment: • Patient in labour – Accelerate labour - Oxytocin drip. APH = ARM

  24. Contd… • Patient not in labour – • Pregnancy 37 wks or more • Induction of labour by low ARM • Caesarean section - fetal distress - complications - control bleeding fails

  25. B. Pregnancy less than 37 wks – • Bleeding moderate to severe & continuing -ARM - Oxytocin drip - C. S • Bleeding slight & has stopped - conservative treatment -close monitoring

  26. II . MIXED or CONCEALED: Principles; • To correct hypovolemia & to restore blood loss • To bring effective uterine contraction & termination of abruption process • To observe blood coagulation profile • Close monitoring

  27. Definitive Treatment: • Blood investigation • To correct hypovolemia • AROM with oxytocin • Vaginal delivery • Caesarean section

  28. COMPLICATIONS: • HAEMORRHAGE • SHOCK • BLOOD COAGULATION DISORDERS • OLIGURIA & ANURIA • POSTPARTUM HAEMORRHAGE • PUERPERAL SEPSIS • ISCHAEMIC NECROSIS

  29. COUVELAIRE UTERUS • Massive intravasation of blood into the uterine musculature upto the serous coat • Condition diagnosed on laparotomy • Uterus is of dark port wine color may be patchy or diffuse • Starts at cornu then spread to other area • Hemorrhage are found under the uterine peritoneum and may extend into the broad ligament • Myometrial hematoma interferes with uterine contractions

  30. COUVELAIRE UTERUS

  31. Fetal Risks • PERNATAL MORTALITY • GROWTH RESTRICTION • CONGENITAL MALFORMATION • ANAEMIA

  32. Nursing Management: • Monitor vital signs & record • Assess amount of blood loss • Assess contraction pattern • Assess urine output &skin color • Send for cross matching & grouping • Administer Morphine if pain present • Put wide bore IV line or CV line • Physical comfort & emotional support • Check fundal height & abdominal girth • Monitor fetal well being

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