Placental abruption and placenta praevia

Calleja‐Agius, Jean; Custo, Romina; Brincat, Mark; Calleja, Neville

doi:10.1007/s11296-006-0046-5

Cited by 29 publications

(18 citation statements)

References 43 publications

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“…Antepartum haemorrhage is defined as bleeding from the genital tract after 24 weeks of gestation and has an incidence of 2-5% of all pregnancies beyond 24 weeks. 11 The causes of antepartum haemorrhage range from cervicitis to placental abnormalities, most commonly placental praevia or placental abruption. 35 A proactive approach should be used for patients at high risk for haemorrhage since preoperative preparedness can improve outcome.…”

Section: Antepartum Haemorrhagementioning

confidence: 99%

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Maternal haemorrhage

Walfish

Neuman

Wlody

2009

British Journal of Anaesthesia

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Maternal haemorrhage is the leading cause of preventable maternal death worldwide and encompasses antepartum, intrapartum, and postpartum bleeding. This review highlights factors that predispose to severe bleeding, its management, and the most recent treatment and guidelines. Advances in obstetric care have provided physicians with the diagnostic tools to detect, anticipate, and prevent severe life-threatening maternal haemorrhage in most patients who have had prenatal care. In an optimal setting, patients at high risk for haemorrhage are referred to tertiary care centres where multidisciplinary teams are prepared to care for and deal with known potential complications. However, even with the best prenatal care, unexpected haemorrhage occurs. The first step in management is stabilization of haemodynamic status, which involves securing large bore i.v. access, invasive monitoring, and aggressive fluid management and transfusion therapy. Care for the patient with maternal bleeding should follow an algorithm that goes through a rapid and successive sequence of medical and surgical approaches to stem bleeding and decrease morbidity and mortality. With the addition of potent uterotonic agents and the advent of minimally invasive interventional radiological techniques such as angiographic embolization and arterial ligation, definitive yet conservative management is now possible in an attempt to avoid hysterectomy in patients with severe peripartum bleeding. If these interventions are inadequate to control the bleeding, the decision to proceed to hysterectomy must be made expeditiously. Recombinant factor VIIa is a relatively new treatment that could prove useful for severe coagulopathy and intractable bleeding.

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Section: Antepartum Haemorrhagementioning

confidence: 99%

“…17 Complications of antepartum haemorrhage include maternal shock, a greater risk of premature delivery, fetal hypoxia, and sudden fetal death, making antepartum haemorrhage an even greater risk to the fetus than to the mother. 11…”

Section: Antepartum Haemorrhagementioning

confidence: 99%

Maternal haemorrhage

Walfish

Neuman

Wlody

2009

British Journal of Anaesthesia

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“…Due to the development of the lower uterine segment during the third trimester, the placenta appears to "move away" from the cervical region. The placenta preferentially grows in the better vascularised area of the corpus and may undergo atrophy in the lower parts of the uterus [2]. During this process, an aberrant vessel can persist over or close to the cervix.…”

Section: Aetiologymentioning

confidence: 99%

Vasa praevia: a lethal threat to the fetus

Ameryckx

Amy

2006

Eur Clinics Obstet Gynaecol

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Vasa praevia constitutes a rare obstetric complication that is potentially lethal for the generally healthy infant. If unrecognized antenatally, the condition carries a higher fetal mortality rate than any other complication in pregnancy. Only in the past two decades have major diagnostic advances led to a dramatic improvement of perinatal survival and lower morbidity rates. Good outcomes depend primarily on prenatal diagnosis and appropriate management. The performance of a caesarean section before rupture of the membranes and the onset of labour is mandatory. Simple modifications of standard screening protocols and the recognition of high-risk patients will allow identification of most cases of vasa praevia. DefinitionIn normal circumstances, the umbilical cord is inserted into the chorionic plate (fetal surface) of the placenta (central or, more frequently, eccentric insertion) or on the placental edge (marginal insertion). The umbilical cord vessels course over the fetal surface before entering the placenta. In about 1% of singleton and 10% of twin pregnancies, however, the umbilical cord vessels separate from each other and start branching at a distance from the placental margin; they run through the membranes, surrounded only by a fold of amnion, before reaching the chorionic plate. If this so-called velamentous insertion is situated in the lower uterine segment, and the unprotected fetal vessels cross the region of the internal cervical os below the presenting fetal part, one speaks of vasa praevia. This aberrant vasculature can also be associated with bilobed or succenturiate placentas, in which case the vessels run between the accessory lobes.Vasa praevia is encountered rarely (1 of 2,500-5,000 deliveries), but even today they are associated with high fetal mortality (∼60%) and morbidity if undiagnosed antenatally [1]. The unprotected umbilical vessels are exposed to compression or rupture, especially during labour or at the time of rupture of the membranes. Laceration of the vasa praevia can rapidly lead to fetal exsanguination, shock (after as little as 60-ml blood loss, corresponding to 20-25% of the feto-placental blood volume) and intrauterine death. The fetus, indeed, has only a small circulatory volume of 80-100 ml/kg. The mother, on the other hand, is not at risk, in contrast to haemorrhages resulting from placenta praevia or abruptio placentae. AetiologySome placentas implant over the uterine isthmus or even over the internal cervical os. Due to the development of the lower uterine segment during the third trimester, the placenta appears to "move away" from the cervical region. The placenta preferentially grows in the better vascularised area of the corpus and may undergo atrophy in the lower parts of the uterus [2]. During this process, an aberrant vessel can persist over or close to the cervix. In cases where the placenta overlies the less vascularised internal os, it may undergo atrophy, which results in the development of a succenturiate lobe and connecting vasa praevia. Beside the aforement...

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“…Haemorrhage is a leading cause of mortality and morbidity of mother and fetus [21]. Previous studies reported that 50% of the women are presented to delivery in emergency room with vaginal bleeding and maternal haemorrhage was reported in 15% -25% of all pregnancies [22,23].…”

Section: Introductionmentioning

confidence: 99%

Effects of Induced Haemorrahge on Thermoregulation, Blood Constituents and Serum Biochemical Parameters in Pregnant and Non-Pregnant Rabbits (Oryctolagus cuniculus)

Sukar

Abdelatif

Alameen

2019

JALSI

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Background and Objectives: Haemorrhage is a leading cause of mortality and morbidity of mother and foetus. Pregnancy is associated with changes which may influence responses to bleeding. This study was designed to examine the influence of controlled haemorrhage and compare thermoregulation and haematological and biochemical parameters in pregnant and nonpregnant rabbits. Materials and Methods: Twelve pregnant and nonpregnant rabbits, 6 in each group, were used in the studies. Both groups of animals were subjected to 20% haemorrhage of total blood volume on gestation day 21. The rectal temperature (Tr), respiratory rate (RR) and heart rate (HR) were monitored for 2 days following bleeding. Blood samples were collected at 24 hrs before induction of bleeding and then after bleeding at 30 min, 24 hrs and 48 hrs. The samples were used for measurements of haematological parameters; coagulation profile, arterial blood gases and serum electrolytes. Results: The general trend indicates lower Tr values in pregnant rabbits at 30 min post-haemorrhage. The values of RR and HR were significantly (P ≤ 0.01) higher in pregnant and nonpregnant animals at 24 hrs post-haemorrhage. The pregnant rabbits showed significant (P<0.05) decrease in platelets count at 24 hrs post-haemorrhage compared to the nonpregnant values. In pregnant rabbits, haemorrhage was associated with significant increase in PT. The activated partial thromboplastin time (APTT) was significantly (P≤ 0.01) prolonged at 24 hrs post-haemorrhage in pregnant and nonpregnant rabbits. The partial pressure of arterial oxygen (PaO2) in pregnant and nonpregnant rabbits was significantly (P≤ 0.01) increased at 24hrs and 48 hrs post-haemorrhage. The partial pressure of arterial carbon dioxide (PaCO2) decreased significantly (P≤0.01) at 30 min post-haemorrhage in pregnant rabbits. There was a slight increase in Na and Ca levels in pregnant rabbits’ post-haemorrhage. Haemorrhage in rabbits was associated with significant decreases in plasma osmolality in pregnant rabbits. Conclusion: Pregnancy induces modifications in some physiological responses to haemorrhage. The information generated could be used in monitoring maternal health during pregnancy and risks of changes associated with haemorrhage in mammals.

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Placental abruption and placenta praevia

Cited by 29 publications

References 43 publications

Maternal haemorrhage

Maternal haemorrhage

Vasa praevia: a lethal threat to the fetus

Effects of Induced Haemorrahge on Thermoregulation, Blood Constituents and Serum Biochemical Parameters in Pregnant and Non-Pregnant Rabbits (Oryctolagus cuniculus)

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