Presentation on theme: "Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital."— Presentation transcript:
Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital
General Consideration Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. Frequency 0.51%-2.33% (our country) 1% (other countries) Incidence of fetal death 200‰-350‰
Pathology Main change hemorrhage into the decidua basalis → decidua splits → decidural hematoma → separation, compression, destruction of the placenta adjacent to it Types revealed abruption, concealed abruption, mixed type Uteroplacental apoplexy 子宫胎盘卒中
Manifestation Vaginal bleeding companied with abdominal pain Mild type abruption≤ 1/3, apparent vaginal bleeding Severe type abruption > 1/3, large retroplacental hematoma, vaginal bleeding companied by persistent abdominal pain, tenderness on the uterus, change of fetal heart rate. shock and renal failure.
Adjunctive Examination Ultrasonography 1.Position of placenta, severity of abruption, survival of fetus 2.Signs: retroplacental hematoma 3.Negative findings do not exclude placental abruption Laboratory examination 1.consumptive coagulopathy: Rt, DIC 2.Function of liver and kidney.
Diagnosis sign and symptom 1.Vaginal bleeding 2.Uterine tenderness or back pain 3.Fetal distress 4.High frequency contractions 5.Hypertonus 6.Idiopathic preterm labor 7.Dead fetus
Treatment Treatment will vary depending upon gestational age and the status of mother and fetus Treatment of hypovolemic shock: intensive transfusion with blood Assessment of fetus Termination of pregnancy: CS or Vaginal delivery
Treatment Treatment of consumptive coagulopathy 1.Supplement of coagulation factors: fresh blood, frozen blood plasma, fibrinogen, blood platelet. 2.Heparin: high coagulation 3.Anti-fibrinolysis Prevention of renal failure