上海交通大学医学院：《妇产科学》（双语） 1 Definition

ABRUPTIO PLACENTAE Lin Qi De

ABRUPTIO PLACENTAE Lin Qi De

Definition Abruptio Placentae( placental abruption): premature separation of the normally implanted placenta from the uterine wall

Definition Abruptio Placentae( placental abruption): premature separation of the normally implanted placenta from the uterine wall

Etiology Mechanism: hemorrhage into the decidua basalis leading to premature placental separation and further bleeding Associated factors o Maternal hypertension o Sudden decompression of the uterus ● Materna| cocaine use trauma

Etiology Mechanism: hemorrhage into the decidua basalis, leading to premature placental separation and further bleeding. Associated factors: •Maternal hypertension •Sudden decompression of the uterus •Maternal cocaine use •trauma

Classification Complete separation: no vaginal bleeding Partial separation/: vaginal bleeding will be apparent Marginal separation vaginal bleeding will be apparent

Classification Complete separation: no vaginal bleeding Partial separation :vaginal bleeding will be apparent Marginal separation : vaginal bleeding will be apparent

diagnosis Classic clinical presentation vaginal bleeding Tender uterus uTerine contractions °Feta| distress

diagnosis Classic clinical presentation: •vaginal bleeding •Tender uterus •Uterine contractions •Fetal distress

Coagulation abnormalities hYpofibrinogenemia oIncreaseing levels of fibrin degradation products decreasing platelet count iNcreasing prothrombin time and partial thromboplastin time o Decreasing other serum clotting factors

Coagulation abnormalities •Hypofibrinogenemia •Increaseing levels of fibrin degradation products •decreasing platelet count •Increasing prothrombin time and partial thromboplastin time •Decreasing other serum clotting factors

Ultrasonography relatively large retroplacental clots may be detected Placental examination The extent of placental abruption of the maternal surface of the placenta on which a clot is detect at the time of delivery

Ultrasonography: relatively large retroplacental clots may be detected Placental examination The extent of placental abruption of the maternal surface of the placenta on which a clot is detect at the time of delivery

Management Maintain hemodynamic stabilization Transfusion therapy o Crystalloid transfusion wHole blood therapy component therapy Correct coagulation status

Management Maintain hemodynamic stabilization ( Transfusion therapy) •Crystalloid transfusion •Whole blood therapy •Component therapy Correct coagulation status

Delivery .When the fetus is mature vaginal delivery is preferable unless there is evidence of fetal distress or hemodynamic instability. When the fetus is not mature and placental abruption is limited, observation with close monitoring of both fetal and maternal status

Delivery •When the fetus is mature,vaginal delivery is preferable unless there is evidence of fetal distress or hemodynamic instability. •When the fetus is not mature and placental abruption is limited,observation with close monitoring of both fetal and maternal status