Callboso lalLh Arky

AbrupLlo lacenLa
AbrupLlo placenLae ls deflned as Lhe premaLure separaLlon of Lhe placenLa from Lhe uLerus aLlenLs wlLh abrupLlo placenLae
also called placenLal abrupLlon Lyplcally presenL wlLh bleedlng uLerlne conLracLlons and feLal dlsLress A slgnlflcanL cause of
LhlrdLrlmesLer bleedlng assoclaLed wlLh feLal and maLernal morbldlLy and morLallLy placenLal abrupLlon musL be consldered
whenever bleedlng ls encounLered ln Lhe second half of pregnancy
Causes
O older age of Lhe moLher
O hlsLory of placenLal abrupLlon durlng a prevlous pregnancy
O hlgh blood pressure or lP
O shorL umblllcal cord
O cerLaln dlsease sLaLes (dlabeLes collagen vascular dlseases)
O Lhe presence of a Lype of uLerlne Lumor called a lelomyoma
O Lwlns LrlpleLs or oLher mulLlple pregnancles
O clgareLLe smoklng
O heavy alcohol use
O cocalne use
O malformaLlons of Lhe uLerus
O malformaLlons of Lhe placenLa
O ln[ury Lo Lhe abdomen (as mlghL occur ln a car accldenL)



Slgns and sympLoms
O AINIUL (sharp and stabb|ng) vaglnal bleedlng
O abdomen ls Lender palnful and Lense (boardllke)
O feLal dlsLress (alLered lP8)
O may lead Lo couve/oire uterus or uterop/ocento/ opop/exy(blood lnfllLraLlng Lhe uLerlne musculaLe) formlng a hard boardllke
uLerus wlLhouL apparenL bleedlng
O heavy bleedlng
O compllcaLlons of abrupLlo placenLa lnclude shock (due Lo blood loss) and coagulopaLhy (ulC) dlssemlnaLed lnLravascular
coagulaLlon
grs of Sparat|on |n Abrupt|o |acnta

O rad 0 no sympLoms of separaLlon were apparenL from maLernal or feLal slgn Lhe dlagnosls LhaL a sllghL separaLlon
dld occur ls made afLer dellvery when Lhe placenLa ls examlned and a segmenL of Lhe placenLa showed a recenL
adherenL cloL on Lhe maLernal slde
O rad 1 Lhls ls mlnlmal separaLlon buL enough Lo cause vaglnal bleedlng and changes ln Lhe maLernal vlLal slgns no
feLal dlsLress or hemorrhaglc shock occurs
O rad 2 Lhls ls moderaLe degree of abrupLlo placenLa

O rad 3 Lhls ls exLreme separaLlon wlLhouL lmmedlaLe lnLervenLlons maLernal shock and feLal deaLh wlll resulL
O Class 0 AsympLomaLlc
O Class 1 Mlld (represenLs approxlmaLely 48 of all cases)
O Class 2 ModeraLe (represenLs approxlmaLely 27 of all cases)
O Class 3 Severe (represenLs approxlmaLely 24 of all cases)

A dlagnosls of class 0 ls made reLrospecLlvely by flndlng an organlzed blood cloL or a depressed area on a dellvered placenLa
Class 1 characLerlsLlcs lnclude Lhe followlng
O -o vaglnal bleedlng Lo mlld vaglnal bleedlng
O SllghLly Lender uLerus
O -ormal maLernal 8 and hearL raLe
O -o coagulopaLhy
O -o feLal dlsLress

Class 2 characLerlsLlcs lnclude Lhe followlng
O -o vaglnal bleedlng Lo moderaLe vaglnal bleedlng
O ModeraLe Lo severe uLerlne Lenderness wlLh posslble LeLanlc conLracLlons
O MaLernal Lachycardla wlLh orLhosLaLlc changes ln 8 and hearL raLe
O leLal dlsLress
O Pypoflbrlnogenemla (le 30230 mg/dL)

Class 3 characLerlsLlcs lnclude Lhe followlng
O -o vaglnal bleedlng Lo heavy vaglnal bleedlng
O Iery palnful LeLanlc uLerus
O MaLernal shock
O Pypoflbrlnogenemla (le 130 mg/dL)
O CoagulopaLhy
O leLal deaLh

@ratmnt
@he flrsL llne of LreaLmenL for placenLal abrupLlon lnvolves replaclng Lhe moLhers losL blood wlLh blood Lransfuslons and flulds
glven Lhrough a needle ln a veln Cxygen wlll be admlnlsLered usually by a mask or Lhrough Lubes leadlng Lo Lhe nose When
Lhe placenLal separaLlon ls severe LreaLmenL may requlre prompL dellvery of Lhe baby Powever dellvery may be delayed when
Lhe placenLal separaLlon ls noL as severe and when Lhe feLus ls Loo lmmaLure Lo lnsure a healLhy baby lf dellvered @he baby ls
dellvered vaglnally when posslble Powever a cesarean secLlon may be performed Lo dellver Lhe baby more qulckly lf Lhe
abrupLlon ls qulLe severe or lf Lhe baby ls ln dlsLress