A seperation of placenta from site of its implantation before

delivery.(latin-rendering placenta as under).

Incidence
• Range of 0.52% - 1.29%.Increases with “increased
gestational age”.

• Perinatal mortality- 119/1000 live births Vs 8.2/1000

due to other causes.
• MATERNAL HYPERTENSION.
• PROM.
• CIGARETTE SMOKING,COCAINE ABUSE.
• THROMBOPHILIAS.
• SUDDEN UTERINE DECOMPRESSION (polyhydramnios).
• EXTERNAL TRAUMA.
• UTERINE LEIOMYOMA.
• PRIOR ABRUPTION.
RISK FACTORS RELATIVE RISK
increased age n parity 1.3-1.5
preeclapmsia 2.1-4.0
chronic hypertension 1.8-3.0
PROM 2.4-4.9
multifetal gestation 2.1
hydramnios 2.0
chronic smoking 1.4-1.9
thrombophilias 3-7
cocaine abuse prior NA
abruption uterine 10-25
leiomyoma NA
Haemorrhage into decidua basalisdecidua splits leaving a thin
layer adherent to myometriumdecidual
haematomaseparation,compression & destruction of placenta.
Decidual spiral artery ruptureretroplacental
haematomathe area of separaton becomes more extensive
upto marginuterus unable to contractblood dissects
membrane from utrine wall & escapes out or remains concealed
REVEALED CONCEALED CONCEALED
• Effusion of blood behind placenta but margin adherent.
• Placenta separeted but membrane still retain their attachment.
• Blood gains access through amniotic cavity.
• Fetal head closely applied to lower segment that prevents
blood escape.
Vaginal bleeding 78% utrine
tenderness 66% fetal distress
60% preterm labour 22%
high frequency of contraction17% hypertonus
17% dead fetus 15%
GRADE 1- not recognised clinically & diagnosed
by retroplacental clots after delivery.

GRADE 2-intermediate,classical signs present but fetus still

alive.

GRADE 3-severe, fetus is dead. 3a-

without coagulopathy. 3b-with
coagulopathy.
WITH VAGINAL BLEEDplacenta praevia, uterine
rupture, vasa praevia.

WITHOUT VAGINAL BLEEDrectus sheath haematoma,

retro peritoneal haemorrhage, rupture of
appendicular abcess, acute degeneration or torsion of
uterine fibroid.
• Hypovolemic shock.

• Acute renal failure.

• DIC.

• Couvelaire uterus.
• ROLE OF IMAGING Poor sensitivity
• When clot visualized,PPV high
• Blood for grouping,crossmatching

• Hb%,PCV

• DIC Profile

• LFT,RFT

• Urine routine
 • Replace blood loss

• Correct coagulopathy

• Deliver the baby

• Aggressive correction despite normal vitals & Hct
• Insert CVP catheter,Foley’s catheter
• Transfuse packed cells
• Expand volume with RL/NS
• 1 FFP after every 4U packed cells
• Maintain PCV 30%,urine O/P of 30 ml/hr
Normal values of DIC profile
Fibrinogen -150 to 600 mg/dl
PT -11 to 16 sec
PTT -22 to 37 sec
Platelet count -1.2 to 3.5 lak/ cmm
D-dimer - <0.5 mg/l
FDP - <10 microgram/dl
• Clot retraction test- For function of platelets

• Clot lysis- Gross measure of fibrinolytic system

• Transfuse 10-20 U of cryoppt if fibrinogen <100 mg/dl

• Transfuse platelets if count <40,000

• Vaginal delivery unless no CI

• Early amniotomy

• Oxytocin infusion

• Time for obtaining delivery upto 24 hrs

• Emer LSCS

• Evaluate hemostatic system

• Speed of delivery important

• Induce and allow for vaginal delivery

• Continuous CTG

• If CTG abnormal,LSCS
• Only in mild cases

• To await lung maturity

• Hospital stay a must