Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT made by sonal Patel
Ăhnlich wie Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT
Ăhnlich wie Abruptio placenta- Define, cause, sign and symptoms, Risk Factors, Incidence,pathology, Classification, Prevention and Treatment, management in PPT (20)
10. Role of ultrasound â limited
â˘Negative findings do not exclude
the diagnosis
â˘U/S is mainly used to confirm fetal
viability, Presentation & position.
â˘To exclude Placenta praevia
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12. Consumptive Coagulopathy
⢠Delee (1901) Temporary hemophilia
Parameters: Fibrinogen < 150 mg/dl,
⢠elevated FDP, D-dimers, decrease in other
coagulation factors
Mechanism: DIC & retro placental clot
formation
⢠Seen in 30% cases of abruption severe
enough to kill the fetus
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13. Acute Renal failure
⢠Pathology: Acute tubular necrosis (75%)
& acute cortical necrosis (25%)
⢠Mechanism: Severe hypovolemia , DIC
along with Underlying preeclampsia
⢠Prevention: Prompt & vigorous
replacement of blood and circulating blood
volume
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14. Differential Diagnosis
1. Without pain: Placenta Previa
2. Without Bleeding: Acute degeneration
or torsion of a fibroid, hematoma of
rectus sheath, rupture of an
appendicular abscess.
3. With mild pain & bleeding: Labour with
heavy show
4. Rupture Uterus
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15. Management
Initial assessment
⢠Monitor vital signs: BP â poor guide to
the extent of bleeding.
⢠Mark the fundal height & measure
abdominal girth
⢠cardiotocographic monitoring of fetus
Investigations: HB, PCV, blood grouping
& typing, BT CT, Clot retraction & lyses,
DIC profile
⢠Foley catheterization & hourly output
chart
⢠watch for bleeding 15
16. Management
âSwift & decisiveâ
Resuscitate the mother
⢠Start an IV line, transfuse Ringer lactate, N
Saline
⢠Two lines if bleeding is severe
⢠Replace blood loss and maintain circulation
⢠Maintain PCV at 30% & urine output >30
ml/hr.
⢠CVP in difficult cases
⢠Delivery
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17. Management
Caesarian section
⢠Live & mature fetus
⢠Delivery not imminent
⢠Fetal distress
⢠No response to induction of labour
⢠Bleeding
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19. Management
Expectant line of management
⢠Doubtful diagnosis
⢠Minor abruption
⢠Preterm gestation
⢠Intensive surveillance & Induction at
or before term
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20. Perinatal mortality
⢠Main danger is to the fetus. If the
abruption is severe enough to threaten the
mother, the fetus will usually be dead
25 fold increase in PMR
⢠Still birth
⢠Prematurity
⢠Hypoxia
⢠Cerebral palsy
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22. Maternal mortality
Case report: woman, who seemed well
enough to wait in an emergency dept for 2
hrs. When the doctor saw her at the end
of this time she was dead!!!
âa fit woman may be able to compensate
for severe hemorrhage until collapse
occurs as a terminal eventâ
⢠A reminder â need to maintain high
standards in obstetric care
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