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Published byMiranda Hancock Modified over 9 years ago
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A placental abruption: - pre-mature separation of normally situated placenta after 22 weeks of pregnancy. - etiology unclear
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- associated factors. sever pre-eclampsia, not chronic HTN. 2. after delivery of 1 st twins,and occurrence ROM. 3. direct trauma to the abdomen RTA. 4. seat belt injury 5. violence. 6. previous c.s 7. High parity. 8. cigarette smoking. 9. ECV. - incidence 0.4-1.8 %
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* partial separation: - bleeding from maternal venous sinus. apparent bleeding from vaginal due to. retained bleeding behind placenta and forced into the myometrium, and infiltrate between muscle fibers [bruised, edematous uterus] -couvelaire uterus -uterine apoplexy
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-clp -no vaginal bleeding. -Signs of hypovolemic shock (concealed Hge ) uterine enlargement. Extreme pain.
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3) Mixed Hge: - bleeding per vagina. - concealed Hge. In the uterine muscle. - revealed, concealed, mixed.
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* according to mother and baby condition mild moderate. sever Hge. assessing mother condition.
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Hx: pre eclampsia.\recent hx of N,V headache, blurred vision. Physical domestic violence appear. ECV - RTA. Delivery of first twins Loss of copious amount of amniotic fluid. Slight localize pain – revealed. - concealed (sever abd. pain.)
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General examination: Anxious, abd pain, pallor edema of the face, fingers, pretibial area. Alteration of v/s, except Bp in case of PIH Respiration & pulse within normal. Temp. :normal – air hunger if sever infection developed fever. Brown dark blood. Fresh bright.
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Abd examination. More than expected gestational age concealed. Hard uterus. Rigid uterus, painful. Gaurading on palpation of abdomen Us CTG Fetal death is common out come
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assessing fetal condition : -fetal movement -CTG -U\s
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management: I Vcanula, CBC, blood group, cross match,clotting factors. psychological care. analgesic for pain morphine 15 mg, pethidine 100- 150mg. differentiate between pain from concealed hemorrhage, or pain from uterine contraction.
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source of pain: bleeding between muscle and membrane of placenta labor pain sub capsular hemorrhage ( pre -eclampsia) management of shock (hypovolemic shock,hemorrhagic plasma or blood transfusion haemacele :-doesn't alter platelet functions,improve renal function position left side,sever shock elevate legs,semi recumbent position
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-midwifery role : Resuscitate mother before surgery Check v\s regularly Cvp Canula in place I&o recorded by indwelling catheter Urinanalysis for proteinuria Fluid requirement should record Fundal height checked regularly Continuous CTG if baby living Anti D for mother RH –ve
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*management of different degree of placental abruption 1-mild (incidental ): Mild separation of placenta ( partial ) Slight vaginal bleeding Mother &fetus in stable condition
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-no signs of shock -abdomen lax -soft uterus -??pp Dx: u/s Rx:u/s -v/s -fetal condition monitoring by CTG -if mother not in labor,< 37 weeks follow up ->37 weeks IOL
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*IOL:done in case of : 1-mild episode of bleeding 2-no evidence of fetal compromise Nb: anemic mother with mild abruption placenta need more concern
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Moderate: Separation of placenta 1\4 -vaginal bleeding -formation of retro placental blood clot C/p: -uterine tenderness -increase pulse rate -decrease blood pressure -hypoxic baby -IUFD
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Management : -manage shock -analgesic -fluid & blood transfusion -cvp monitoring -continuous CTG -vaginal birth : contracted & stop bleeding after birth -psychological support * augmentation of labor :1-amniotomy ROM 2-oxytocin infusion
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- sever type : -acute emergency condition -detachment of placenta 2\3 -life threatening condition -most of blood concealed -sever shock decrease blood pressure,if normal suspect pre-eclampsia cases -fetus almost died -sever abdominal pain -board like abdomen
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* Complications DIC -RF Pituitary dysfunction -The same as moderate treated by blood transfusion, cs delivery in case of sever bleeding cvp pain relief
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*Care of the baby: Asphyxia (pediatrician, equipment well prepared) may need neonatal ICU physical care : full information and explanation to the family.
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Partner support. If baby go neonatal ICU "visit her" Let mother to handle her baby before going to nursery. N.B abruption placenta has a risk factor for recurrence in the next pregnancy.
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Complications DIC is a complication of moderate to severe placental abruption. Postpartum hemorrhage may occur as a result of the Couvelaire uterus and disseminated intravascular coagulation, or both. Intravenous ergometrine 0.5 mg is given at birth as a prophylactic measure. Renal failure may occur as a result of hypovolaemia and consequent poor perfusion of the kidneys.
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Pituitary necrosis is another possible consequence of prolonged and severe hypotension (also known as Sheehan's syndrome; see medical texts for details of this rare condition). The maternal mortality rate due to placental abruption is 1%
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شكرا لحسن الإستماع
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