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Abruptio Placenta : definition , clinical feature, complication, management

pratiksha.jagtap30.2017@gmail.com

ABRUPTIO PLACENTA

Definition :
“It is one form of antepartum hemorrhage where the bleeding occurs due to premature separation of normally situated placenta “
INCIDENT : 
  • 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
Types of Abruptio placenta : 
There are mainly three type of abruptio placenta…..

 

  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. GRADE 0 : Clinical features may be absent . The diagnosis is made after inspection of placenta following delivery.
    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. 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.
CLINICAL FEATURES OF ABRUPTIO PLACENTA :    
Clinical features depends upon the degree of separation of placenta  , type of abruptio placenta
    • Abdominal pain
    • Vaginal bleeding
    • Uterine contraction
    • Abdominal tenderness
COMPLICATION OF ABRUPTIO PLACENTA :   
    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
     2. FETAL :
    •    Fetal death may occur
    • prematurity
    • Anoxia

MANAGEMENT :

The patient is to be treated as outlined in placenta previa and arrangement should be made to shift the patient to an equipped maternity unit as early as possible.

PREVENTION :

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