COMPLICATIONS OF ABRUPTIO PLACENTAE-audio

MATERNAL: In revealed type – maternal risk is proportionate to the visible blood loss and maternal death is rare.

In concealed variety – The following complications may occur either singly or in combinations. (1)Hemorrhage which is either totally concealed inside the uterus or more commonly, part is revealed outside. There may be intraperitoneal or broad ligament hematoma (2) Shock may be out of proportion to the blood loss. Release of thromboplastin into the maternal circulation results in DIC or there may be amniotic fluid embolism (3) Blood coagulation disorders ( see above) (4) Oliguria and anuria due to-(a) hypovolemia (b) serotonin liberated from the damaged uterine muscle producing renal ischemia and (c) Acute tubular necrosis. How ever, a severe case may lead to (d) cortical necrosis and renal failure (5) Postpartum hemorrhage due to – (a) atony of the uterus and (b) increase in serum FDP (6) Puerperal sepsis.

The complicating factors that are responsible for increased material death varies from 2 -8 %. However, with better understanding in the management of shock, coagulation failure and renal failure, maternal death has been reduced markedly. Some cases who manage to survive may develop features of ischemic pituitary necrosis. There is failure of lactation (Sheehan’s syndrome) later on.

FETAL: In revealed type, the fetal death is to the extent of 25 – 30%. In concealed type, however, the fetal death is appreciably high, ranging from 50 – 100 %. The deaths are due to prematurity and anoxia due to placental separation. With same degree of placental separation, the fetus is put to more risk in abruptio placentae than in placenta previa. This is due to the presence of pre-existing placental pathology with poor functional reserve in the former, in contrast to an almost normal placental functions in the latter.

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