上海交通大学医学院：《妇产科学》（双语） 19 Placental Abruption

Placental Abruption Liu we Department of ob Gy Ren Ji hospital

Placental Abruption Liu Wei Department of Ob & Gy Ren Ji hospital

General consideration Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. Frequency 0.51%-233%o(our country) 1%o(other countries) Incidence of fetal death 200%-350‰

General Consideration • Definition The separation of the placenta from its site of implantation after 20 weeks of gestation or during the course of delivery. • Frequency 0.51%-2.33% (our country) 1% (other countries) • Incidence of fetal death 200‰-350‰

Etiology Uncertain(primary cause) Risk factors 1. Increased age and parity 2. Vascular diseases: preeclampsia, chronic hypertension, renal disease. 3. Mechanical factors: trauma, intercourse polyhydramnios, Supine hypotensive syndrome 5. Smoking, cocaine use, uterine myoma

Etiology • Uncertain (primary cause) • Risk factors 1. Increased age and parity 2. Vascular diseases: preeclampsia, chronic hypertension, renal disease. 3. Mechanical factors: trauma, intercourse, polyhydramnios, 4. Supine hypotensive syndrome 5. Smoking, cocaine use, uterine myoma

Pathology Main change hemorrhage into the decidua basalis -> decidua splits→ decidural hematoma→ separation, compression, destruction of the placenta adjacent to it Types revealed abruption, concealed abruption, mixed type Uteroplacental apoplexy子宫胎盘卒中

Pathology • Main change hemorrhage into the decidua basalis → decidua splits → decidural hematoma → separation, compression, destruction of the placenta adjacent to it • Types revealed abruption, concealed abruption, mixed type • Uteroplacental apoplexy 子宫胎盘卒中

CONCEALED HEMORRHAGE PARTIAL PLACENTA PREVIA PLACENTAL ABRUPTION EXTERNAL HEMORRHAGE OOF贬 D FROM EHE

Pathology

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Manifestation Vaginal bleeding companied with abdominal pain Mild type abruptions 1/3, apparent vaginal bleeding Severe type abruption >1/3, large retroplacental hematoma, vaginal bleeding companied by persistent abdominal pain, tenderness on the uterus, change of fetal heart rate shock and renal failure

Manifestation • Vaginal bleeding companied with abdominal pain • Mild type abruption≤ 1/3, apparent vaginal bleeding • Severe type abruption > 1/3, large retroplacental hematoma, vaginal bleeding companied by persistent abdominal pain, tenderness on the uterus, change of fetal heart rate. shock and renal failure

Adjunctive Examination Ultrasonography 1. Position of placenta, severity of abruption, survival of fetus 2. Signs: retroplacental hematoma 3. Negative findings do not exclude placental abruption Laboratory examination 1. consumptive coagulopathy: rt, DIC 2. Function of liver and kidney

Adjunctive Examination • Ultrasonography 1. Position of placenta, severity of abruption, survival of fetus 2. Signs: retroplacental hematoma 3. Negative findings do not exclude placental abruption • Laboratory examination 1. consumptive coagulopathy: Rt, DIC 2. Function of liver and kidney

Diagnosis ° sign and sympton 1. Vaginal bleeding 2. Uterine tenderness or back pain 3. Fetal distress 4. High frequency contractions ypertonus 6. Idiopathic preterm labor 7. Dead fetus

Diagnosis • sign and symptom 1. Vaginal bleeding 2. Uterine tenderness or back pain 3. Fetal distress 4. High frequency contractions 5. Hypertonus 6. Idiopathic preterm labor 7. Dead fetus