1. Liu Wei Department of Ob & Gy Ren Ji hospital
Placental Abruption
Liu Wei
Department of Ob & Gy
Ren Ji hospital

2. 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‰

3. Etiology Uncertain (primary cause) Risk factors
Increased age and parity
Vascular diseases: preeclampsia, chronic hypertension, renal disease.
Mechanical factors: trauma, intercourse, polyhydramnios,
Supine hypotensive syndrome
Smoking, cocaine use, uterine myoma

4. 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

5. Pathology

8. 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.

9. Adjunctive Examination
Ultrasonography
Position of placenta, severity of abruption, survival of fetus
Signs: retroplacental hematoma
Negative findings do not exclude placental abruption
Laboratory examination
consumptive coagulopathy: Rt, DIC
Function of liver and kidney.

10. Diagnosis sign and symptom Vaginal bleeding
Uterine tenderness or back pain
Fetal distress
High frequency contractions
Hypertonus
Idiopathic preterm labor
Dead fetus

11. Diagnosis Ultrasonography Differential diagnosis Placenta previa
Painless bleeding
Pre-rupture of uterus
dystocia

12. Complication DIC Hypovolemic shock Amnionic fluid embolism
Acute renal failure

13. 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

14. Treatment Treatment of consumptive coagulopathy
Supplement of coagulation factors: fresh blood, frozen blood plasma, fibrinogen, blood platelet.
Heparin: high coagulation
Anti-fibrinolysis
Prevention of renal failure

15. END