medical notes

Apr 17th, 2015
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ABRUPTIO PLACENTAEDefinitionsAbruptio placenta refers to premature separation of a normally implanted placenta after twenty weeks of gestation, but prior to delivery of the infantThe immediate cause of the separation is rupture of defective maternal vessels in the decidua basalis, where it interfaces with the placental anchoring villi. Rarely, the bleeding can originate from the fetal-placental vesselsThe accumulating blood splits the decidua, separating a thin layer with its placental attachment from the uterus. The resultant hematoma may be small and self-limited (partial abruption) or may continue to dissect through the placental-decidual interface leading to complete or near complete placental separation (total abruption) Since the detached portion of the placenta is unable to exchange gases and nutrients, the fetus can become compromised if the area of separation is large.ClassificationTwo principal forms of premature separation of the placenta may be recognized depending on whether the resulting hemorrhage is external or concealedConcealed form: (20%), the hemorrhage is confined within the uterine cavity, detachment of the placenta may be complete, and the complications are often severe. Approximately 10% of abruptions are associated with clinically significant coagulopathies (disseminated intravascular coagulation [DIC]). External form: (80%), the blood drains through the cervix, placental detachment is more likely to be incomplete, and the co

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