c

c 

Abruptio placentae is defined as the premature separation of the placenta from

the uterus. Patients with abruptio placentae typically present with bleeding, uterine
contractions, and fetal distress. A significant cause of third-trimester bleeding
associated with both fetal and maternal morbidity and mortality, abruptio placentae must
be considered whenever bleeding is encountered in the second half of pregnancy.

Basing on our research about the rate of incidence of the in the said case in the
Philippines. We can utter that cases of abruptio placenta is very exceptional in our
country. The most affected country is Malta with a rate of 2.5092 deaths per 1 million
people. Followed by Estonia with 0.750188 deaths per 1 million people .

The frequency of abruptio placentae in the United States is approximately 1%,

and a severe abruption leading to fetal death occurs in 0.12% of pregnancies (1:830).
While for its mortality/morbidity the risk of perinatal mortality is reported as 119 per
1,000 people in the United States, but this can depend on the extent of the abruption
and the gestational age of the fetus.Currently, placental abruption is responsible for
approximately 6% of maternal deaths. Placental abruption is more common in African
American women than in either white or Latin American women. However, whether this
is the result of socioeconomic, genetic, or combined factors remains unclear. An
increased risk of placental abruption has been demonstrated in patients younger than
20 years and those older than 35 years.

While multiple risk factors are associated with abruptio placentae, only a few
events have been closely linked to this condition, including the following previous
placental abruption, prolonged rupture of membranes (24 h or longer), preeclampsia
,hypertension, maternal age of 35 years or older, low socioeconomic status, trauma,
cocaine abuse, cigarette smoker

We choose this case because it will give us more idea on how to deal with it. And we
also want to help our patient and as well as our future patients to be with the same case with
her to have its optimal level of care and wellness. Through this we would be able to understand
more about abruption placenta.

 
    
   

A urinalysis is simply an analysis of the urine. It is a very common test that can
be performed in many healthcare settings including doctors' offices, urgent care
facilities, laboratories, and hospitals. It is performed by collecting a urine sample from
the patient in a specimen cup. Usually only small amounts (10-15 ml's) may be required
for urinalysis testing.

    

Color: pale yellow Pus cells:0-2/hpf

Appearance: turbid Red blood cells:0-2/hpf
Specific gravity:1.010 Epithelial cells: abundant
Glucose: negative Bacteria: few
Protein: negative Amorphous
Mucus threads
Casts
Crystal
Others

Urine may be cloudy (turbid) because it contains red or white blood cells, bacteria, fat,
mucus, digestive fluid (chyle), or pus from a bladder or kidney infection.

In fixed specific gravity, the specific gravity of the urine remains at 1.010 no matter how
much fluid the person drinks. This condition occurs in patients who have chronic inflammation of
the small blood vessels.

Usually, glucose, ketones, protein, bilirubin, are not detectable in urine.

 s   
s 


Immunochromatographic Assay

Hepatitis B virus (HBV) tests check for substances in the blood that show
whether a hepatitis B infection is active or has occurred in the past.

  Non-reactive

This means that patient X i
not been infected with hep B, but still at risk for
possible future infection that¶s why it needs protection such as the hep B vaccine.

 !
 "

Ultrasound imaging, also called ultrasound scanning or 

 #, involves
exposing part of the body to high-frequency sound waves to produce pictures of the
inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays).
Because ultrasound images are captured in real-time, they can show the structure and
movement of the body's internal organs, as well as blood flowing through blood vessels.

 The fetus is in cephalic presentation with 48.5mm.Ac is 224.5 mm and Fl is 51.1.

Fetal heart rate of 149 beats per minute. No purity grade of 1 without os encroachment
equivalent to 2.4 lbs.
 "!

$  "     " %   c! 

Complete Blood
County
Total WBC 11.2 5.0-10.0 X10^9/L
Total RBC 3.15 3.69-5.90 X10^12/L
Hemoglobin 10.0 11.70-14.0 g/L
Hematocrit 31.2 34.10-44.0
MCV 99.0 70.0-97.00 fL
MCH 31.7 26.10-33.30 pg
MCHC 32.1 32.00-35.00 g/dL
RDW-CV 12.9 11.00-16.0
Platelet Count 313,00 150,00-139,00 X10^g/L
Differential
Count
Neutrophil 74.3 55.0-62.0 %
Lymphocyte 17.9 20.0-40.0 %
Monocyte 6.7 4.0-10.0 %
Eosinophils 0.9 1.0-6.0 %
Basophils 0.2 0.00-1.00 %
 A decreased number of RBCs results from either acute or chronic blood loss.
Acute blood loss is a rapid depletion of blood volume. Chronic blood loss stems from
various conditions that often results in some form of an anemia. This is due to loss of
small amounts of blood over a long period of time (bleeding), mechanical destruction of
the RBCs, or some physiologic problem.

A high WBC count can be an indicator of an infection, inflammation, or allergy

Low hematocrit may be due to Anemia , Blood loss (hemorrhage), Bone marrow
failure, Destruction of red blood cells, Leukemia, Malnutrition

Increased MCV it means that there is B12 and Folate deficiency. A deficiency in B12 can
also result in varying degrees of neuropathy, nerve damage that can cause tingling and
numbness in the patient¶s hands and feet and mental changes that range from confusion and
irritability to severe dementia.

Increased number of platelets may have a tendency to bleed due to the lack of
stickiness of the platelets; in others, the platelets retain their stickiness but, because they are
increased in number, tend to stick to each other, forming clumps that can block a blood vessel
and cause damage.

Neutrophils are also increased in any acute inflammation.Increased in bacterial

infections; low numbers leave person very susceptible to infection.

White blood cells are generally considered a indication of infection in the

body. A low level may indicate the body has just finished its job or that you have
just "gotten over" an illness. White blood cell count include several types of cells,
lymphocytes are only one.
 
#

$&$ "


Date: Blood Fetal Contraction Duration Interval IE Station BOW

Pressure Heart s intensity Dilation
8/10/09
Rate

7am 110/70 140 Strong 60 sec. 3/10 6-7 (-) (+)

8am 142 Strong 60 sec. 3/10 10 (-) (+)

$ &$ "


% 
 ' " () " () (* " ("

Blood Pressure 100/70 100/70 100/70 110/70

Temperature 36.9 36.9 36.9 36.7

Pulse rate 66 69 67 74

Respiratory Rate 20 21 20 21

?
 
+ $s+c,+


The "  !-  " contains two main parts: the uterus, which
hosts the developing fetus, produces vaginal and uterine secretions, and passes the
male's sperm through to the fallopian tubes; and the ovaries, which produce the
female's egg cells. These parts are internal; the vagina meets the external organs at the
vulva, which includes the labia, clitoris and urethra. The vagina is attached to the uterus
through the cervix, while the uterus is attached to the ovaries via the Fallopian tubes. At
certain intervals, the ovaries release an ovum, which passes through the Fallopian tube
into the uterus.

If, in this transit, it meets with sperm, the sperm penetrate and merge with the egg,
fertilizing it. The fertilization usually occurs in the oviducts, but can happen in the uterus
itself. The zygote then implants itself in the wall of the uterus, where it begins the
processes of embryogenesis and morphogenesis. When developed enough to survive
outside the womb, the cervix dilates and contractions of the uterus propel the fetus
through the birth canal, which is the vagina.

The ova are larger than sperm and are generally all created by birth. Approximately
every month, a process of oogenesis matures one ovum to be sent down the Fallopian
tube attached to its ovary in anticipation of fertilization. If not fertilized, this egg is
flushed out of the system through menstruation.


%
 

The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the
body in female mammals, or to the cloaca in female birds and some reptiles. Female
insects and other invertebrates also have a vagina, which is the terminal part of the
oviduct.

The vagina is the place where semen from the male is deposited into the female's body
at the climax of sexual intercourse, commonly known as ejaculation. Around the vagina,
pubic hair protects the vagina from infection and is a sign of puberty.

-.

The cervix is the lower, narrow portion of the uterus where it joins with the top end of the
vagina. It is cylindrical or conical in shape and protrudes through the upper anterior
vaginal wall. Approximately half its length is visible; the remainder lies above the vagina
beyond view.

 

The uterus or womb is the major female reproductive organ of humans. One end, the
cervix, opens into the vagina; the other is connected on both sides to the fallopian
tubes.

The uterus is a pear-shaped muscular organ. Its major function is to accept a fertilized
ovum which becomes implanted into the endometrium, and derives nourishment from
blood vessels which develop exclusively for this purpose. The fertilized ovum becomes
an embryo, develops into a fetus and gestates until childbirth. If the egg does not
embed in the wall of the uterus, a woman gets her period and the egg is flushed away.

-! 

The Fallopian tubes or oviducts are two very fine tubes leading from the ovaries of
female mammals into the uterus.

On maturity of an ovum, the follicle and the ovary's wall rupture, allowing the ovum to
escape and enter the Fallopian tube. There it travels toward the uterus, pushed along
by movements of cilia on the inner lining of the tubes. This trip takes hours or days. If
the ovum is fertilized while in the Fallopian tube, then it normally implants in the
endometrium when it reaches the uterus, which signals the beginning of pregnancy.


-  

The ovaries are the place inside the female body where ova or eggs are produced. The
process by which the ovum is released is called ovulation. The speed of ovulation is
periodic and impacts directly to the length of a menstrual cycle.

After ovulation, the ovum is captured by the oviduct, after traveling down the oviduct to
the uterus, occasionally being fertilized on its way by an incoming sperm, leading to
pregnancy and the eventual birth of a new human being.

The Fallopian tubes are often called the oviducts and they have small hairs (cilia) to
help the egg cell travel.

$  

The placenta is an organ unique to mammals that connects the developing fetus to the
uterine wall. The placenta supplies the fetus with oxygen and food, and allows fetal
waste to be disposed of via the maternal kidneys. The word ÷

comes from the
Latin for 
, from Greek ÷

÷


, accusative of ÷
÷

 -
 , "flat, slab-like", referring to its round, flat appearance in humans.
Protherial (egg-laying) and metatherial (marsupial) mammals produce a choriovitelline
placenta that, while connected to the uterine wall, provides nutrients mainly derived
from the egg sac. The placenta develops from the same sperm and egg cells that form
the fetus, and functions as a fetomaternal organ with two components, the fetal part
(Chorion frondosum), and the maternal part (Decidua basalis).

$   

     

In preparation for implantation, the uterine endometrium undergoes 'decidualisation'.

Spiral arteries in the decidua are remodelled so that they become less convoluted and
their diameter is increased. This increases maternal blood flow to the placenta and also
decreases resistance so that shear stress is reduced. The relatively high pressure as
the maternal blood enters the intervillous space through these spiral arteries bathes the
villi in blood. An exchange of gases takes place. As the pressure decreases, the
deoxygenated blood flows back through the endometrial veins.Maternal blood flow is
approx 600±700 ml/min at term.


/   

Deoxygenated fetal blood passes through umbilical arteries to the placenta. At the
junction of umbilical cord and placenta, the umbilical arteries branch radially to form
chorionic arteries. Chorionic arteries also branch before they enter into the villi. In the
villi, they form an extensive arteriocapillary venous system, bringing the fetal blood
extremely close to the maternal blood; but no intermingling of fetal and maternal blood
occurs ("placental barrier"[5]).










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Bleeding into the decidua basalis leads to separation of the placenta. Hematoma
formation further separates the placenta from the uterine wall, causing compression of
these structures and compromise of blood supply to the fetus. Retroplacental blood may
penetrate through the thickness of the uterine wall into the peritoneal cavity, a
phenomenon known as Couvelaire uterus. The myometrium in this area becomes
weakened and may rupture with increased intrauterine pressure during contractions. A
myometrium rupture immediately leads to a life-threatening obstetrical emergency.
Severity of fetal distress correlates with the degree of placental separation. In near-
complete or complete abruption, fetal death is inevitable unless an immediate cesarian
delivery is performed.

Ü 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

Ü 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.

 
 

#"#

j A large loss of blood or hemorrhage may require blood transfusions and

intensive care after delivery.
j The uterus may not contract properly after delivery so the mother may need
medication to help her uterus contract. 'APH weakens, for PPH to kill'.
j The mother may have problems with blood clotting for a few days.
 j If the mother's blood does not clot (particularly during a caesarean section) and
too many transfusions could put the mother into disseminated intravascular
coagulation (DIC) due to increased thromboplastin, the doctor may consider a
hysterectomy.
j A severe case of shock may affect other organs, such as the liver, kidney, and
pituitary gland. Diffuse cortical necrosis in the kidney is a serious and often fatal
complication.
j In some cases where the abruption is high up in the uterus, or is slight, there is
no bleeding, though extreme pain is felt and reported.

# 

j If a large amount of the placenta separates from the uterus, the baby will
probably be in distress until delivery. It may die  , resulting in a stillbirth.
j The baby may be premature and need to be placed in the newborn intensive
care unit. He or she might have problems with breathing and feeding.
j If the baby is in distress in the uterus, he or she may have a low level of oxygen
in the blood after birth.
j The newborn may have low blood pressure or a low blood count.
j If the separation is severe enough, the baby could suffer brain damage or die
before or shortly after birth.

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