Definition:- This is other type of ante-partum hemorrhage . In this form of APH where bleeding due to premature separation of normally situated placenta.
(1) Revealed:- Following separation of placenta in blood insiuates downward between membrane & deciduas ultimately blood comes out by cervical canal to be visible externally .
(2) Concealed:- :- The blood collects behind separated placenta or collected between in membrane & decidua .
(3) Mixed:- In this type of placenta some part of blood collect inside & a part is expelled out .
-The exact cause of abruptio placenta is obscure or unknown
-Advancing age of mother
-High birth order pregnancy
-Poor socio economic condition
-Hypertension in pregnancy
-Sudden uterine decompression
Clinical Features :-
-Depend upon degree of separation of placenta
-Small to moderate amount of bright or dark red vaginal bleeding
-Acute abdominal pain followed by vaginal bleeding
-General condition of pts is shock
-Fetal heart sound usually present in revealed or usually absent in concealed.
-Fetal part can be identified usually easily in revealed & difficult in concealed.
-Urine output normal in revealed & usually diminish in concealed .
Diagnostic Investigation :-
–Blood for hemoglobin
–Urine for protein
–Complete blood count
Management:- The following guidelines may be helpful in prevention :-
– Prevention, early detection & effective therapy of pre-eclampsia.
– Needle puncture during amniocentesis.
– Avoidance of trauma.
– Avoid sudden decompression of uterus.
– Avoid supine hypotension.
– Routine administration of folic acid
The Pts is shift to equipped hospital as early as possible –Assessment of case (amount of blood, time , gestation period, bleeding ,pts is in labour or not).
-If patient is in labour , the labour is increased by low rupture of membrane .
-IF patients is not in labour & pregnancy 37 weeks or more, the induction of labour is done by low rupture of membrane.
-Fetal heart sound