a placental abruption: - pre-mature separation of normally situated placenta after 22 weeks of...
DESCRIPTION
* partial separation: - bleeding from maternal venous sinus. apparent bleeding from vaginal due to. retained bleeding behind placenta and forced into the myometrium, and infiltrate between muscle fibers [bruised, edematous uterus] -couvelaire uterus -uterine apoplexyTRANSCRIPT
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A placental abruption: - pre-mature separation of normally situated
placenta after 22 weeks of pregnancy.- etiology unclear
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- associated factors.
sever pre-eclampsia, not chronic HTN.2. after delivery of 1st twins ,and occurrence ROM .3. direct trauma to the abdomen RTA.4. seat belt injury5. violence.6. previous c.s7. High parity.8. cigarette smoking.9. ECV. - incidence 0.4-1.8 %
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* partial separation:
- bleeding from maternal venous sinus. apparent bleeding from vaginal due to .retained bleeding behind placenta and
forced into the myometrium, and infiltrate between muscle fibers [bruised, edematous uterus]
-couvelaire uterus-uterine apoplexy
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-clp-no vaginal bleeding.-Signs of hypovolemic shock (concealed Hge )uterine enlargement.Extreme pain.
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3) Mixed Hge:- bleeding per vagina.- concealed Hge. In the uterine muscle.- revealed , concealed , mixed.
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* according to mother and baby condition
mildmoderate.sever Hge.assessing mother condition.
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Hx: pre eclampsia.\recent hx of N ,V headache , blurred vision.
Physical domestic violence appear .ECV - RTA.Delivery of first twinsLoss of copious amount of amniotic fluid .Slight localize pain – revealed.- concealed (sever abd. pain.)
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General examination:Anxious , abd pain, palloredema of the face, fingers, pretibial area.Alteration of v/s, except Bp in case of PIH Respiration & pulse within normal. Temp. :normal – air hunger if sever infection developed fever.Brown dark blood .Fresh bright.
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Abd examination.More than expected gestational age
concealed .Hard uterus.Rigid uterus, painful.Gaurading on palpation of abdomenUs CTG Fetal death is common out come
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assessing fetal condition :-fetal movement-CTG-U\s
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management:I Vcanula , CBC , blood group , cross
match ,clotting factors.psychological care.analgesic for pain morphine 15 mg , pethidine
100-150mg.differentiate between pain from concealed
hemorrhage, or pain from uterine contraction.
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source of pain:
bleeding between muscle and membrane of placenta
labor pain sub capsular hemorrhage ( pre -eclampsia)management of shock (hypovolemic
shock ,hemorrhagic plasma or blood transfusion haemacele :-doesn't alter platelet functions ,improve
renal function position left side ,sever shock elevate legs ,semi
recumbent position
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-midwifery role :
Resuscitate mother before surgery Check v\s regularly CvpCanula in place I&o recorded by indwelling catheter Urinanalysis for proteinuria Fluid requirement should record Fundal height checked regularly Continuous CTG if baby living Anti D for mother RH –ve
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*management of different degree of placental abruption 1-mild (incidental ):Mild separation of placenta ( partial )Slight vaginal bleeding Mother &fetus in stable condition
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-no signs of shock -abdomen lax -soft uterus-??ppDx: u/s Rx:u/s -v/s -fetal condition monitoring by CTG -if mother not in labor ,< 37 weeks follow up->37 weeks IOL
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*IOL:done in case of :1-mild episode of bleeding 2-no evidence of fetal compromise Nb: anemic mother with mild abruption
placenta need more concern
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Moderate:
Separation of placenta 1\4-vaginal bleeding -formation of retro placental blood clot C/p:-uterine tenderness-increase pulse rate -decrease blood pressure -hypoxic baby -IUFD
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Management :-manage shock -analgesic -fluid & blood transfusion -cvp monitoring-continuous CTG -vaginal birth : contracted & stop bleeding after birth -psychological support * augmentation of labor :1-amniotomy ROM 2-oxytocin infusion
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- sever type :
-acute emergency condition -detachment of placenta 2\3 -life threatening condition -most of blood concealed -sever shock decrease blood pressure ,if
normal suspect pre-eclampsia cases -fetus almost died -sever abdominal pain -board like abdomen
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* ComplicationsDIC -RF Pituitary dysfunction -The same as moderate treated by blood
transfusion, cs delivery in case of sever bleeding
cvppain relief
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*Care of the baby:Asphyxia (pediatrician, equipment well
prepared)may need neonatal ICU physical care :full information and explanation to the family.
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Partner support.If baby go neonatal ICU "visit her"Let mother to handle her baby before going
to nursery.N.B abruption placenta has a risk factor for
recurrence in the next pregnancy.
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Complications
DIC is a complication of moderate to severe placental abruption.
• Postpartum hemorrhage may occur as a result of the Couvelaire uterus and disseminated intravascular coagulation, or both. Intravenous ergometrine 0.5 mg is given at birth as a prophylactic measure.
• Renal failure may occur as a result of hypovolaemia and consequent poor perfusion of the kidneys.
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Pituitary necrosis is another possible consequence of prolonged and severe hypotension (also known as Sheehan's syndrome; see medical texts for details of this rare condition).
• The maternal mortality rate due to placental abruption is 1%
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