As abruptio placentae refers gwöhnlich after the 20th week of pregnancy (SSW) the premature solution of a normally implanted placenta from the uterus wall. It can be an obstetric emergency. For symptoms, vaginal bleeding, pain and tenderness of the uterus, hemorrhagic shock and disseminated intravascular coagulation (DIC) may belong. The diagnosis is made clinically or sometimes ultrasound. The treatment consists in mild symptoms in an altered activity (z. B. Experimental bed rest) and maternal or fetal instability or a nearby date of birth in an immediate delivery.
A placental abruption occurs in 0.4-1.5% of all pregnancies; the peak incidence is 24 to 26 weeks of gestation.
As abruptio placentae refers gwöhnlich after the 20th week of pregnancy (SSW) the premature solution of a normally implanted placenta from the uterus wall. It can be an obstetric emergency. For symptoms, vaginal bleeding, pain and tenderness of the uterus, hemorrhagic shock and disseminated intravascular coagulation (DIC) may belong. The diagnosis is made clinically or sometimes ultrasound. The treatment consists in mild symptoms in an altered activity (z. B. Experimental bed rest) and maternal or fetal instability or a nearby date of birth in an immediate delivery. A placental abruption occurs in 0.4-1.5% of all pregnancies; the peak incidence is 24 to 26 weeks of gestation. A placental abruption can include any degree of placental separation of a few millimeters until complete detachment. The replacement can be acute or chronic. It leads to bleeding into the decidua basalis behind the placenta (retroplacental). In most cases the etiology is unknown. Risk factors include the following risk factors: Higher maternal age hypertension (pregnancy induced or chronic) ischemia of the placenta (ischemic placental disease), which manifests as intra-uterine growth retardation Polyhydramnios intraamnial infection (chorioamnionitis) vasculitis Other Vascular Earlier Abruptio placenta abdominal trauma Acquired maternal thromboembolic disease tobacco use Premature rupture of cocaine use (risk up to 10%) complications following complications can occur: Maternal blood loss leading to heme can lead odynamischer instability, with or without shock, and / or a disseminated intravascular coagulopathy (DIC) Fetus (eg. As fetal distress, death) or if it is placental abruption a chronic (which is the rule) is, growth Occasionally fetomaternal transfusion and alloimmunization (z. B. due to Rh sensitization). Symptoms and complaints by an acute placental abruption can cause a light or dark red blood discharge from the cervix are (external bleeding). Blood can also be behind the placenta remaining (hidden bleeding). The severity of the symptoms and findings depends on the extent of the solution and the amount of blood loss. With increasing detachment of the uterus may hurt spontaneous, pressure-sensitive and be irritated by palpation. There may be a hemorrhagic shock and also signs of DIC. In chronic placental abruption occurs persistent or intermittent dark brown spots. A placental abruption can also show little or no symptoms and discomfort. Diagnosis combination of clinical, laboratory and ultrasound findings, the diagnosis is likely if one of the following symptoms in late pregnancy occurs: Vaginal bleeding (painful or painless) pain and tenderness of the uterus Fetal distress or death Hemorrhagic Shock Disseminated intravascular coagulopathy degree of sensitivity to pain or the shock is not commensurate with the severity of vaginal bleeding, the diagnosis should be considered in women with abdominal trauma into consideration. If during late pregnancy to a vaginal bleeding, placenta previa has showing similar symptoms are ruled out before the examination of the pelvis is performed; can previa in the presence of placental bleeding are amplified by the investigation. To study include fetal heart monitoring Complete blood count blood and Rh-typing PT / PTT determination of serum fibrinogen and fibrin degradation products (the most sensitive indicator) abdominal or pelvic ultrasonography Kleihauer-Betke test in patient with Rh-negative blood for calculating the required amount of Rh0 (D) immunoglobulin When monitoring fetal heartbeats to a pathological frequency patterns or even fetal death can represent. Consists of abdominal sonography of suspected placenta previa, transvaginal sonography is required. However, the findings with both ultrasound methods can be normal in placental abruption. Tips and risks A normal findings on ultrasound includes an abruption placentae not made. Treatment is occasionally immediate delivery and aggressive accompanying measures (z. B. at near-birth date or maternal or possible fetal instability) attempt a stationary receiving and modified bed rest, when the pregnancy is not close to the date and if the mother and fetus are stable An immediate caesarean usually indexed when one of the following criteria apply, especially when contraindicated vaginal delivery: Maternal hemodynamic instability conspicuous fetal heart rate pattern pregnancy is close to the date (. eg> 36 weeks) if a delivery is deemed necessary, a vaginal delivery be attempted if the mother hemodynamically stable, the fetal heart rate pattern is unobtrusive and vorl no contraindication to vaginal delivery IEGT (. eg by placenta previa or vasa previa); the birth can be carefully initiated or accelerated (z. B. using oxytocin and / or amniotomy). For postpartum hemorrhage preparations should be made. Hospitalization and modified bed rest are recommended if all the following conditions are true: The bleeding does not threaten the life of the mother or fetus. The fetal heart rate pattern is normal. Pregnancy is not close to the deadline. This approach ensures that the mother and fetus closely monitored and, if necessary, can be treated quickly. (Altered resting behavior includes a waiver of any activity that increases intra-abdominal pressure for a long time, for. Example, women should not be the most of the day on their feet.) Corticosteroids should in pregnancies <34 weeks to accelerate lung maturity should be considered. If the bleeding stops and the maternal and fetal status remain stable, are standing up and walking around, and usually also allows the discharge from the hospital. Stops the bleeding or deteriorates the statute, an immediate cesarean section may be indicated. Complications (z. B. shock, DIC) are treated by aggressive replacement of blood and blood products. Summary A hemorrhage in placenta abruption can be external or hidden. Occasionally causes a placental abruption only slightly pronounced symptoms and discomfort. The diagnosis should not be excluded if the findings (including ultrasound) are inconspicuous. An immediate Caesarean section should be taken into consideration when the life of the mother or fetus are threatened or the pregnancy is close to the deadline Vaginal delivery should be considered when the mother and fetus are stable and the pregnancy is close to the deadline.