Difference between revisions of "Placental abruption"
Revision as of 23:12, 18 July 2011
- premature separation of placenta from uterus
- amount of external bleeding may not correlate with severity of abruption since bleeding may be concealed.
- fetal death by hypoxia. can also cause fetal blood loss, maternal Rh sens, amniotic fluid embolism, DIC.
- GRADE 3/ COMPLETE- mod to severe bleeding with painful tetanic uterine contractions. maternal hypotension and tachycardia. DIC with fibrinogen levels less than 150 mg/%, representing a blood loss of 2L. Maternal coagulopathy with thrombocytopenia, clooting factor, fibrinogen depletion. fetal death common.
- GRADE 2/ PARTIAL- ex ut bleeding mild to mod, uterine irritability with tetanic comtractions at times, maternal orthostatic hypotension, fibrinogen levels 150- 250 mg/%, fetal distress with compromised fetal heart rate patterns
- GRADE 1/ MILD- spotting with limited ut irritabillity- no organizedcontractions. Mat BP normal, fibrinogen normal at 450 mg/%, normalfetal heart rate.
- mat hypertension
- eclampsia, preeclampsia
- h/o prev abruption
- ut distension from multiple gestations, hydramnios, tumors
- vascular dz- collagen vasc, DM, CRF
- coccaine- increases BP
- microangiopathic hemolytic anemia
- premature rupture of membranes
- uterine blunt trauma- mva, domestic violence
- short umbilical cord
- advanced mat age,
- male fetal gender
- short umbilical cord
abd pain, ut contractions, vag bleeding. possibly also mat hypoTN,tachycardia, ARDS, ATN, DIC- (bruising, hematuria)
- Thrombomodulin (marker for endothelial cell damage) is elevated
- DIC- triggered by massive hem. stumulates production of tissue thromboplastin causing extensive microvascular clotting; these small clots stumulate the fibrinolytic cascade which leads to cosumpiton of platelets, fibrinogen and other clotting factors.
- normal fibrinogen is 450, at 300 see spont bleeding at puncture sites, at 150- mother has already lost 2L
- DIC panel- fibrinogen, platelets, pt/ptt, raised D- dimer- from fibrin degredation
- will still fail to detect 50% of cases
- can measure gest age if mom unsure- if near term do crash c seciton.
- will see if hematoma is subchorionic, retroplacental or preplacental- will not change management other that to rule out placenta previa
- stable/ grade 1- admit for observation and elective delivery
- if pt with large concealed hem, are at risk for ut rupture. tx c decompression of of ut cavity by amniotomy- only do if all other resuscitative measures are failing.
- xfuse saline, blood, ffp, platelets as needed.
- emergent c section if near term. if preterm, use tocolytics- mag sulfate and terbutaline to prevent ut contractions and prevent labor