ABRUPTIO PLACENTAE课件.pptVIP

ABRUPTIO PLACENTAE Lin Qi De * * Definition Abruptio Placentae( placental abruption): premature separation of the normally implanted placenta from the uterine wall. Etiology Mechanism: hemorrhage into the decidua basalis, leading to premature placental separation and further bleeding. Associated factors: Maternal hypertension Sudden decompression of the uterus Maternal cocaine use trauma Classification Complete separation: no vaginal bleeding Partial separation :vaginal bleeding will be apparent Marginal separation : vaginal bleeding will be apparent diagnosis Classic clinical presentation: vaginal bleeding Tender uterus Uterine contractions Fetal distress Coagulation abnormalities Hypofibrinogenemia Increaseing levels of fibrin degradation products decreasing platelet count Increasing prothrombin time and partial thromboplastin time Decreasing other serum clotting factors Ultrasonography: relatively large retroplacental clots may be detected Placental examination The extent of placental abruption of the maternal surface of the placenta on which a clot is detect at the time of delivery. Management Maintain hemodynamic stabilization ( Transfusion therapy) Crystalloid transfusion Whole blood therapy Component therapy Correct coagulation status Delivery When the fetus is mature,vaginal delivery is preferable unless there is evidence of fetal distress or hemodynamic instability. When the fetus is not mature and placental abruption is limited,observation with close monitoring of both fetal and maternal status. Bleeding is caused by seperation of part of the placenta from the lower uterine segment and cervix,possibly in response to mild uterine contractions. If the placenta lies in the posterior portion of the lower uterine segment,its exact relation with the internal os may be more difficult to ascertain. In these instances,transvaginal ultrasonography is useful adjunct to the transabdominal approach. To distinguish abruption placentae from olacen