ABRUPTIO PLACENTAE

Lin Qi De

Definition
Abruptio Placentae( placental abruption):
premature separation of the normally implanted placenta from the uterine wall.

Etiology
Mechanism: hemorrhage into the decidua
basalis, leading to premature placental separation and further bleeding.

Associated factors:
Maternal hypertension Sudden decompression of the uterus Maternal cocaine use trauma

Classification
Complete separation: no vaginal
bleeding

Partial separation :vaginal bleeding

will be apparent

Marginal separation : vaginal

bleeding will be apparent

diagnosis
Classic clinical presentation:
vaginal bleeding Tender uterus Uterine contractions Fetal distress

Coagulation abnormalities
Hypofibrinogenemia

Increaseing levels of fibrin degradation products

decreasing platelet count Increasing prothrombin time and partial thromboplastin time Decreasing other serum clotting factors

Ultrasonography:
relatively large retroplacental clots may be detected

Placental examination
The extent of placental abruption of the maternal surface of the placenta on which a clot is detect at the time of delivery.

Management
Maintain hemodynamic stabilization ( Transfusion therapy)
Crystalloid transfusion

Whole blood therapy

Component therapy

Correct coagulation status

Delivery
When the fetus is mature,vaginal delivery is preferable unless there is evidence of fetal distress or hemodynamic instability. When the fetus is not mature and placental abruption is limited,observation with close monitoring of both fetal and maternal status.