This has been documented in Britain as between 0.5%-2% of pregnancies, but varies depending on the criteria used for diagnosis. Where the diagnosis is based on histological examination of the placenta the incidence has been reported to be as high as 4%. From the annual report of 2003 the incidence in UPTH is 1.5%.
Spontaneous rupture of the placental bed blood vessels. Leads to haematoma formation. In the concealed type the haematoma accumulates, causing increasing pressure and separation of the placenta. Some blood might dissect into the myometrium causing COUVELAIRE uterus
The blood may also rupture through the membranes and gain access to the amniotic fluid. With the disrupted placental site, there is reduced metabolic exchange resulting in fetal hypoxia and probable death. The process might continue with the release of tissue Thromboplastin into the maternal circulation causing Disseminated Intravascular Coagulopathy.
HISTORY --Vaginal bleeding usually dark and non-clothing. However bleeding may be absent. --Abdominal pain This increase in severity --Back pain -Absence of fetal movement -Symptoms of shock Restlessness, sweating dizziness
The uterus may be larger than gestation. A tender uterus, describe as woody hard. it does not relax. Fetal parts are difficult to palpate. The fetal heart rate may or may not audible. Vaginal examination is not done if the diagnosis is in doubt.
If placenta praevia is ruled out, then vaginal examination will show evidence of bleeding in the reveal type. The cervical os may be dilated if the patient is in labour, or closed if not in labour.
Expectant management:-especially when gestational age favors delaying the delivery to allow greater fetal maturity. All facilities for monitoring feto-maternal well being must be available before this can be done. Anytime there is a deviation, for resuscitation and emergency delivery.
Abruptio Placentae is an important cause of fetal and maternal morbidity and mortality. The aetiology is poorly understood , various management options are however available. The principle of initial assessment of the patients condition and subsequent planned management aimed at resuscitation and prolongation of pregnancy if possible or immediate delivery either for fetal or maternal indications .