Written by Dr.M.D.Mazumdar, MD
Placental Abruption is also called 'Abruptio Placentae'.
It is a type of Antepartum Haemorrhage. Other causes of antepartum hemorrhage are Placenta previa, cervical erosion, cervical polyp, cervical carcinoma and varicose veins of the vagina or vulva.
Placental abruption or Abruptio Placentae is a condition in which there is premature separation of a normally situated placenta in the upper part of the uterus before delivery of the baby, or sometimes even before labor begins.
Bleeding occurs between the placenta and the uterine wall and can either trickle out between the amniotic membranes or collect as a blood clot between the placenta and the uterine wall.
The blood clot gradually increases in size, separating the placenta more and more from its attachment to the uterine wall. This can be highly dangerous since it decreases the blood flow to the fetus.
The incidence of placental abruption is 0.42%. It tends to recur in 8.8% of patients.
There are three clinical types of placental abruption.
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The signs and symptoms varies depending on whether the placental abruption is of the revealed or concealed type.
The fetus is usually healthy. The foetal heart beat is normal.
The fetal parts are not easily felt and the fetal heart may not be heard as there may be death of the foetus in the uterus.
Treatment of placental abruption is again different in the different types - revealed and concealed. All patients with a history of vaginal bleeding should always be investigated by ultrasonography and treatment depends to a great deal on the USG report.
If the patient has come in labour, she is allowed to proceed under intensive monitoring.
If the foetus is a mature term foetus, cesarian section is done as early as possible to minimize blood loss.
If the patient has come in shock, she is promptly resuscitated with IV fluids, blood transfusion etc. An emergency cesarian section is done as early as possible to cut down on the blood loss.
If the patient is in labor and is expected to deliver almost immediately, she is allowed to proceed, keeping her ready for a cesarian section.
In most patients, the fetus is dead at the time of treatment.
Cesarian hysterectomy In some patients with concealed type of placental abruption, the retroplacental clot may be very large. There may even be bleeding into the muscle and blood vessels of the uterus, causing injury and damage. Blood can leak out of the damaged vessels to collect in the muscles, causing edema and necrosis of the uterine muscles. The damage may be enough to cause minute bruise and ecchymoses on the surface of the uterus. This is called a 'Couvelaire Uterus'.
The Couvelaire uterus sometimes is too damaged to contract and control bleeding after delivery of the baby. A cesarian hysterectomy (removal of the uterus) becomes necessary to control the haemorrhage.
Mortality due to Placental Abruption:
The incidence of maternal mortality is about 3.9% and mainly caused by severe anemia (61.6%) and puerperal infections (7.9%). Foetal mortality is 37.77%.
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