2. Introduction
• Bleeding from the genital tract in pregnancy
from age of viability 24 week’s gestation (
according to WHO) and the onset of labour.
• It affects 4% of all pregnancies.
• It is associated with increased risks of fetal
and maternal morbidity and mortality
5. Introduction
Definition: Abruptio placentae is defined as
the premature separation of the placenta
from the uterus
• Also called placental abruption
• Abruptio placentae also occurs in about 1% of
all pregnancies throughout the world.
8. Presentation
• Vaginal bleeding/ no bleeding if its Concealed
• Tense, tenderness Uterine or back pain.
• Fetal distress.
• High frequency contractions.
• Uterine hyper tonus.
• Decreased/absent fetal movements (IUFD.)
9. Classification
Grade 0. Asymptomatic, small retroplacental
clot after delivery
Grade 1. External vaginal bleeding
• Uterine tetany and tenderness may be present
• No signs of maternal shock
• No evidence of fetal distress
10. Grade 2.
• External vaginal bleeding may or may not be present
• Uterine tender and tetany.
• No signs of maternal shock
• Signs of fetal distress present
Grade 3.
• External bleeding may or may not be present
• Marked uterine tetany
• Maternal shock
• Fetal death or distress
• Coagulopathy in 30% of the cases
12. Diagnosis of Abruptio
• The diagnosis is clinical.
• U/S: to Confirm fetal viability, assess fetal
growth & normality, measure liquor, do
umbilical artery Doppler velocities.
• U/S to exclude placenta praevia
13. Principles of management
1. Early delivery (50% of abruption present in labour).
2. Adequate blood transfusion.
3. Adequate analgesia.
4. Detailed maternal and fetal monitoring.
5.Coagulation profile (30% develop DIC).
6. C/S: distressed baby, severe bleeding, alive baby & not
in advanced labour.
7. Vaginal delivery: very low gestation, dead baby, cervix
is fully dilated.
Anti-D if the mother is rhesus negative.
15. Introduction
Definition: The presence of placental tissue
overlying or proximate to the internal cervical
os after viability. OR
- This is when the placental is lying on the lower
segment of the uterine
Incidence: Complicates approximately 1 in 300
pregnancies
17. Types of Placenta Previa
• Type I:
The placental edge is in the lower uterine segment but does not reach the
internal os
• Type II:
The placental edge reaches the internal os but does not cover it.
• Type IIA- Placenta is anterior
• Type IIB - placenta is posterior
• Type III:
The placenta covers the internal os when it is close and is asymmetrically
situated (partial).
• Type IV:
The placenta covers the internal os and is centrally situated (complete)
18. Clinical presentation of Placenta
Praevia
• Bleeding: usually mild but it could be severe;
recurrent, painless.
• Soft uterus.
• Normal fetal heart rate (unless there is severe
bleeding or associated abruption).
• High presenting part.
• Fetal malpresentation
(breech/transverse/oblique).
• Vaginal examination is contraindicated.
20. Complications of Placenta praevia
• Preterm delivery.
• Preterm premature rupture of membranes.
• IUGR (repeated bleeding).
• Malpresentation; breech, oblique, transverse.
• Fetal abnormalities (double in PP).
• ↑ number of C/S.
• Postpartum haemorrhage: lower segment not
contract and retract
21. Management of Placenta Praevia
• Depends on gestational age (GA), severity of APH and
the type of placenta praevia:
• Placenta praevia at term has to be delivered
• If heavy APH, then take theatre for caesarean section
• If minimal/moderate APH and preterm, then admit to
antenatal ward, keep X-matched, keep IV access with
large-bore cannulae at all times and do OB ultrasound
(US).
• Steroids if GA 26-34 wks: dexamethasone 6 mg IM
every 12 hrs x 4 doses.
• If no heavy bleeding, then wait and do elective
caesarean delivery at 37 wks gestation.
23. Introduction
• Vasa previa is a very rare condition refers to
vessels that traverse the membranes in the
lower uterine segment in advance of the fetal
head.
• Rupture of these vessels can occur with or
without rupture of the membranes and result
in fetal exsanguination.
25. Introduction
• Def: dissolution in continuity of the uterine wall anytime
beyond 28/40,before this called perforation
• Uterine rupture in pregnancy is often catastrophic
complication with a high incidence of fetal and maternal
morbidity.
• Abdominal pain or free fluid
• Tender abdomen
• Easily palpable fetal parts
• Absent fetal movements
• Absent fetal heart sounds
• NO abdominal contractions
• Treatment is repairing the rupture or hysterectomy
26. Risk factors of uterine rupture
• Previous operations on the Uterus like C/S, Myomectomies
• Classical C/S carries a high risk than lower transverse C/S
• The higher the number of C/S the higher the risk of rupture
• Grand multiparty
• Induction of labor
• Augmentation of labor with oxytocics
• Obstructed labor
• Use of forceps delivery
• Direct trauma
