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REPORT
ANTENATAL HISTORY
4 PNCUs at local health center
Daily multivitamins intake with FeSo4
Good diet with regular intake of milk and
water
REVIEW OF SYSTEMS
General Survey: (-) weight gain, fever, chills,
Skin: (-) rashes, pruritus
Head and Neck: (-) headache
CNS: (-) loss of consciousness, nausea
CVS: (-) easy fatigability, palpitations
Respiratory: (-) difficulty of breathing, chest pain,
cough, hemoptysis
GIT: (-) vomiting, polydipsia, vomiting, dysphagia
GUT: (-) polyuria, diarrhea, constipation, dysuria,
hematuria
Musculoskeletal: (+) pelvic pain, (+) bipedal
edema
transfusions
(-) allergies to food or meds
FAMILY HISTORY
PERSONAL & SOCIAL HISTORY
Maternal & Paternal: u/r
Personal/Social History: u/r
Sexual History
Coitarche: 17 yo with her husband
(-) STDs
OBSTETRIC HISTORY
Gravi
da
G1
Year
Term
1994
G2
1996
FT
(NSD)
FT
(NSD)
G3
2011
Place of
Delivery
home
Complicati
ons
(-)
home
(-)
Present Pregnancy
CONTRACEPTIVE HISTORY
none
Vital Signs:
BP: 140/110 mmHg
HR: 92 bpm
RR: 18
Temp: 37.1C
HEENT:
Head: normocephalic
Eyes: not bulging or protruding, pale palpebral
conjunctiva, anicteric sclera,
Ears: (-) visible masses, tenderness, discharge
Nose: symmetrical, midline septum, no nasal flaring
Throat: moist oral mucosa, no swelling,tongue
midline, (-) TPC
Neck: supple neck, trachea on midline, thyroid is
not enlarged, (-) LAD
heaves/thrills
Auscultation: normal rate, regular rhythm,
no murmurs
ADMITTING DIAGNOSIS
Methyldopa, FeSo4
LABORATORY TESTS
CBC Results
June 19 (Pre- June 20 (Day June
22
Op)
1 Post-Op)
(Day
3
Post-Op)
RBC
Hemoglobin
2.20 (L)
59 (L)
2.75 (L)
80 (L)
3.07 (L)
89 (L)
Hematocrit
WBC count
Neutrophils
Lymphocyte
0.18 (L)
26.4 (H)
0.898 (H)
0.070 (L)
0.23 (L)
38.4 (H)
0.883 (H)
0.072 (L)
0.27 (L)
19.2 (H)
N
0.197 (H)
LABORATORY TESTS
Coagulation
June 19 (Pre- June 21 (Day 2
Op)
Post-Op)
Prothrombin 12.3
Time
PT INR
1.02
PT % 72.8
Activity
APTT
35.2
9.1 (L)
0.76
176.4
34.9
LABORATORY TESTS
Glucose
BUN
Crea
Blood Chemistry
3.42 (L)
3.07
73.91 mmol/L
AST
Na
K
Cl
Mg
AST (06/20/11)
53 (H)
136
3.4 (L)
101
0.88
48 (H)
ABRUPTIO PLACENTA
accidental hemorrhage
Incidence: 1/100-1/200 deliveries
Common cause of intrauterine fetal demise
Occurs when all or part of the placenta
ABRUPTIO PLACENTA
Degree of Detachment:
Partial
Complete
As to Onset
Acute
Chronic
As to Type
External hemorrhage bet. the membranes and uterus
Concealed hemorrhage retained bet the detached
placenta and uterus
Marginal sinus rupture limited to the edge
parity
Preeclampsia
PROM
Thrombophilias
Maternal trauma
Prior abruption
Smoking
Cocaine use
Uterine leiomyoma
tenderness - 70%
Fetal distress* - 60%
Abnormal uterine contractions (eg,
hypertonic, high frequency)* - 35%
Idiopathic premature labor - 25%
Fetal death - 15%
Salient Features
Abruptio Placenta
38 yo
nd
Variable
Continuous
Placenta Previa
More common <19 or >
35
nd
rd
2 & 3 trimester
Variable
Often ceases w/in 1-2
hrs
Moderate
profuse
Red (bright)
Painful
UTZ Findings
(-) fetal heart tone
Internal Exam:
3 cm cervical
dilatation, 50%
effaced, cephalic
presentation,
floating, (+) BOW
PPROM
Before 37 weeks
Sudden gush of
Variable quantity
of clear or slightly
turbid, nearly
colorless liquid
abnormal placentation
Oligohydramnios
Pooling of blood
Leaking bag of
water
Asstd w/ other
obstetric
ABRUPTIO PLACENTA :
Diagnosis
Clot formation retroplacentally
Ultrasonography and doppler imaging
Non-specific markers (thrombomodulin)
significantly elevated
ABRUPTIO PLACENTA
Hemorrhage into the decidua basalis
Decidual hematoma
ABRUPTIO PLACENTA :
Management
Institute crystalloid fluid resuscitation for the
ABRUPTIO PLACENTA
Vaginal Delivery
fetus is dead
Cesarean Delivery
live and mature fetus
if vaginal delivery is not imminent
ABRUPTIO PLACENTA :
Complications
Couvelaire uterus
extravasation of blood into the uterine
musculature and beneath the uterine serosa
blue or purple
Acute Renal Failure
massive hemorrhage impaired renal perfusion
Consumptive Coagulopathy