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Published byRussell Kelly Modified over 9 years ago
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Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital
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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‰
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Etiology Uncertain (primary cause) Risk factors 1.Increased age and parity 2.Vascular diseases: preeclampsia, chronic hypertension, renal disease. 3.Mechanical factors: trauma, intercourse, polyhydramnios, 4.Supine hypotensive syndrome 5.Smoking, cocaine use, uterine myoma
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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
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Pathology
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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.
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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.
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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
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Diagnosis Ultrasonography Differential diagnosis 1.Placenta previa Painless bleeding 2.Pre-rupture of uterus dystocia
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Complication DIC Hypovolemic shock Amnionic fluid embolism Acute renal failure
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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
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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
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