Abruptio Placenta : definition , clinical feature, complication, management

• overall incidence is about 1 in 100 deliveries
• Abruptio placenta contributes nearly 30% of all APH cases and majority  (60%) occurs in the third trimester of pregnancy

1. Revealed abruptio placenta
2. Concealed abruptio placenta
3. Mixed abruptio placenta

• REVEALED ABRUPTIO PLACENTA : Separation of the placenta , the blood insinuates downwards between the membranes and the decidua . Ultimately , the blood comes out of the cervical canal to be visible externally. This is the most common type

• CANCEALED ABRUPTIO PLACENTA : The blood collects behind the separated placenta or collected in between the membranes and decidua . The collected blood is prevented from coming out of the cervix by the presenting part which presses on the lower segment . At times , the blood may percolated into the amniotic sac after rupturing the membranes

• MIXED ABRUPTIO PLACENTA : In this type , some part of blood collects inside(concealed)  and a part is expelled out (revealed). Usually one variety predominate over the other. This is quite common type .

ETIOLOGY OF ABRUPTIO PLACENTA : 

• • High birth order (pregnancy with gravida >5)
• Advance age of mother
• Poor socioeconomic condition
• Low nutritional status
• Smoking (vasospasm)
• Hypertension in pregnancy
• Trauma
• Sudden uterine decompression
• Short cord
• Supine hypotension syndrome
• Placental anomaly
• sick placenta
• Folic acid deficiency
• Uterine factor (placenta implanted over the septum )
• Torsion of uterus
• Cocaine abuse
• Thrombophilias
• Hyperhomocysteinemia
• Prior abruption (risk of recurrence)

Clinical classification : Depending upon the degree of placental abruption and its clinical effect the grade as follow……

1. 1. GRADE 0 : Clinical features may be absent . The diagnosis is made after inspection of placenta following delivery.

1. 1. GRADE 1(40%) : Vaginal bleeding is slight Uterus is irritable , tenderness may be minimal or absent .Maternal BP and fibrinogen levels unaffected . FSH is good

1. 1. GRADE 2 (45%) : Vaginal bleeding is mild to moderate .Uterine tenderness is marked ,      Maternal pulse increased, BP is maintained .Fibrinogen level may be decreased . Shock is absent. Fetal distress or even Fetal death occurs.

• • Abdominal pain
  • Vaginal bleeding
  • Uterine contraction
  • Abdominal tenderness

1. 1. MATERNAL :  

• • maternal death is rare in revealed type of abruptio placenta.
  • Hemorrhage
  • Shock
  • Blood coagulation disorder
  • Oliguria or anuria due to hypovolemia
  • Postpartum hemorrhage
  • Puerperal sepsis

• •    Fetal death may occur
  • prematurity
  • Anoxia

MANAGEMENT :

PREVENTION :

1. Administration of iron and folic acid supplement
2. Early detection of pre – eclampsia
3. Early detection of hypertensive disorder.