ABRUPTIO PLACENTAE

B.HEMANATH
DEFINITION

 Abruptio Placentae(syn. Accidental

haemorrhage, Premature placental separation):
It is one form of APH where bleeding occurs due to
premature separation of normally situated placenta.
TYPES
 Revealed
 Concealed or complete separation

 Mixed

 Marginal separation

 Partial separation

 Pre-placental separation

 Couvelaire uterus
TYPES
ETIOLOGY
Predisposing factors
• Hypertension in pregnancy
• High Birth order
• Advanced Age of mother
• Smoking
• Poor Socio Economic
Status
• Malnutrition
Other Etiological Factors
• Trauma
• Sudden uterine
decompression
• Short Cord
• Supine Hypotension
syndrome
• Placental Anomaly
• Folic Acid deficiency
• Placenta implanted over
septate uterus
• Torsion of uterus
• Cocaine abuse
• Thrombophilias
• Prior abruption
PATHOGENESIS
Etiological factors

Haemorrhage into decidua basalis and hematoma formation

Degeneration and necrosis of decidua basalis with adjacent placenta

Rupture of basal plate forming communication b/w hematoma and

intervillous space

Fluid and blood percolate into myometrium upto serous coat(couvelaire

uterus)

Sometimes serosa split open and blood enters into peritoneal

cavity
PATHOLOGY
 Usually retro placental hematoma not evident
 It is evident only after expulsion by features like
 depression on maternal surface with clot
 areas of infarction

 Couvelaire uterus
 Dark port wine colour
 Sub peritoneal petechial haemorrhages
 Free blood in peritoneum sometimes
 Other Organs
 Liver – fibrin knots in sinusoids
 Kidneys – ATN and ACN
 Shock proteinuria
 CLINICAL GRADING

Grade 0 Grade 1 Grade 2 Grade 3

• No Clinical • Vaginal • Vaginal • Vaginal
Features. bleeding bleeding mild bleeding
Diagnosis slight to moderate severe
made after • Uterus • Uterus • Uterus
placental tenderness tenderness
minimal present marked
inspection tenderness
following • Maternal pulse • Shock occurs
• Maternal BP increased and • Foetal death is
delivery
and fibrinogen a rule
fibrinogen levels associated
levels decreased with anuria
normal • Foetal distress coagulation
• FHS good or death defect
 CLINICAL FEATURES:
Mixed
Revealed
(Concealed predominate)

Abd. Discomfort followed by vaginal Acute abdominal intense pain

bleeding followed by slight vaginal bleeding
Symptoms

Character of Dark colour continuous Blood stained serous discharge

bleeding continuous
General Proportionate to visible blood loss Disproportionate shock usually
condition present
Proportionate to GA Disproportionately enlarged
Uterine ht.

Normal with local tenderness Tense, tender and rigid

Uterus feel

Fetal parts Easily identified Difficult

FHS Present Absent
Normal diminished
UO
 CLINICAL FEATURES: LABORATORY

Mixed
Revealed
(Concealed predominate)

Low proportionate to blood loss Markedly lower disproportionate to

blood loss
HB%

Unchanged Variable changes

Coagulation
Profile

May be absent Usually present

Urine for protein
ULTRASONOGRAPHY
 To rule out placenta praevia but not diagnostic
 Early haemorrhage is hyperechoic or isoechoic

 Negative findings do not exclude placental

abruption
DIFFERENTIAL DIAGNOSIS
 Revealed
 With placenta praevia
 With indeterminate bleeding

 Mixed or Concealed
 With rupture uterus
 With rectus hematoma
 With appendicular perforation
 With volvulus
PROGNOSIS
 Depends on
 Clinical types
 Degree of placental separation
 Interval b/w placental separation and baby delivery and
efficacy of treatment

 Bleeding is almost always maternal

MANAGEMENT
o Prevention
• Elimination of known factors
• Correction of anaemia
• Prompt detection and institution of therapy to avoid complications
o Treatment
• At home:-treated as said in placenta praevia and shifted
immediately to well equipped hosp.
• At hosp :-
 Assessment of case
 Emergency measures
 Management options
a) Definitive
b) Management of complications
c) Expectant management
THANK YOU