CLINICAL FEATURES

The clinical features of the revealed and mixed variety are:

Revealed Mixed, Concealed
features predominant
Symptoms Abdominal discomfort -The client seized with
or pain followed by acute intense pain on
vaginal bleeding (slight) abdomen followed by
slight vaginal bleeding,
pain continuous.
Character of bleeding Continuous dark colour -Continuous, dark colour
or blood stained serous
discharge
General Condition Proportionately blood -Shock is pronounced,
loss, shock is absent which is out of
proportionate to the
visible blood loss
Pallor -Related with visible -Pallor is usually severe
blood loss and out of proportionate
to visible blood loss
Features May be absent -Either pre-existing or
Of preeclampsia appear for first time.

Uterine height -Proportionate to the May be

period of gestation. disproportionately
enlarged and globular.
Uterine Feel -Localised tenderness, -Uterus is tense, tender
contractions frequent and rigid.
and local amplitude
Fetal parts Can be identified easily. Difficult to make out.
Fetal heart sounds Usually present. Usually absent.

Urine out put Normal Usually diminished

INVESTIGATIONS:
Ultrasonography: Retro placental mass could be seen in 20-25 % of cases
LABORATORY Makedly lower out of
Blood: HB % Low value proportionate to blood
proportionate to the loss
blood loss
Coagulation profile -Usually unchanged -Clotting time increases
more than 6 min.
-Low fibrinogen level
less than 150 mg/dl.
-Low platelet count
Increased partial
thromboplastin time and
fibrin degradation
products

Urine for protein May be absent Usually present

Confusion diagnosis With placenta praevia With Acute obstetrical-

Withheld vaginal gynocological surgical
examination. complication.

Differences between placenta praevia abruption placenta

Features Placenta Praevia Abruptio Placenta
Nature of Bleeding - Painless, apparently -Painful, often
causeless, recurrent. attributed to
- Bleeding always preeclampsia or trauma.
revealed -Revealed, concealed
and mixed

-Dark coloured.
Character of Blood: -Bright red
-Out of proportionate to
General condition and -Proportionate to visible blood loss in
anemia visible blood loss concealed type.

-Present in 1/3 of cases.

Features of -Not relevant
preeclampsia
-May be
Abdominal -Proportionate height. disproportionately
examination: enlarged in concealed
Height of the uterus type.

-May be tensed, tender,

Feel of uterus -Soft and relaxed. and rigid.

-Unrelated
Mal presentation -Common
-Usually absent.
Fetal heart sounds -Usually present.
-Placenta in upper
Placentography. -Placenta in lower segment.
segment.
-Placenta not felt at
Vaginal examination. -Placenta felt at lower lower uterine segment
uterine segment but there is presence of
blood clots.