,primigravida 37wks of gestation came with h/o bleeding PV.on examination,uterus is tender ,cervix well effaced,4cm dilated and membranes present . USG shows placenta well above OS .it was blood stained liquor after rupture of membranes ..her antenatal records shows ,she is on labetolol since one month..CTG shows heart rate around 80 -90bpm.I Proceeded with LSCS ,,alive baby of 2.8 kg delivered ..Intra -op image of uterus is given below . Q.1)what is the clinical diagnosis of this condition . Q.2)what is the name given to such intra -op image of uterus Q.3)Is hysterectomy is needed for such uterus or no surgical intervention is needed for such uterus .

primi with 8MA with regular ANC and fetal Doppler normal on 22 .05.2017.ft ft wt 1.7 kgs corresponding to 32 wks. GTT, thyroid profile normal. today she came with tightening of abdomen at 1.00pm o/E uterus ht corresponding to 36 wks. fhs ?, cephalic, liquor adequate. p/v cx 70%effaced,os admiting 2 fingers strechable . check Ed in scan placentalooks hypertrophied. ? abruptio placenta. at around 2.30 pm liquor clear. inj tramazac given.iv epidosin drip started. vital normal.coagulation profile normal. one pint blood ready for transfusion. deliver a male baby of wt 1.65 kg. placenta with clots of wt 800 mg seen. delivered at 5.45 pm. blood transfusion done.pph controlled. what are the causes of abruptio placenta and how can it be prevented.

ABRUPTIO PLACENTA. Placental abruption is premature separation of normally implanted placenta after the 20th week of gestation and before the 3rd stage of labour. It is a significant cause of antepartum hemorrhage and a potentially fatal complications of pregnancy. CLINICAL PRESENTATION. *Antepartum bleeding. *Painful uterine contractions. *Fetal distress. PATHOLOGY. rupture of a spiral artery with hemorrhage into the decidua basalis leading to separation of the placenta. RISK FACTORS. *PIH and hypertension. *Maternal trauma. *Maternal age >>>>35 years. *Increased parity. *Maternal cigarette smoking. *Maternal cocaine use. *Previous placental abruption. *Thrombophilia. *Chorioamnionitis. *Prolonged rupture of membranes. *Short cord. Depending on the position of abruption it is classified as *Marginal abruption. *Retro placental abruption. *Pre placental abruption. CLASSIFICATION OF ABRUPTION . Based on location and extent of abruption. CLASS 0 Asymptomatic. Diagnosed retrospectively by finding an organized blood clot on a delivered placenta. CLASS 1 Mild. Mild vaginal bleeding. Slightly tender uterus. Normal B.P and heart rate. No coagulopathy. No fetal distress. CLASS 2 Moderate. Moderate vaginal bleeding. Moderate uterine tenderness and tetanic contractions. Maternal tachycardia. Orthostatic changes in B.P and heart rate. Fetal distress. Hypofibrinogenemia. CLASS 3 Severe. Heavy vaginal bleeding. Painful tetanic uterus. Maternal shock. Hypofibrinogenemia. Coagulopathy. Fetal death. RADIOGRAPHIC DIAGNOSIS. ULTRASOUND. *Poorly echogenic retro placental clot. *Intra placental anechoic areas. *Separation and rounding of the placental edge. *Thickening of placenta>>5 cms. *Thickening of the retro placental myometrium normally it should be 1-2 mm. *Disruption of retro placental circulation. *Intra amniotic echoes due to intra amniotic hemorrhage. *Intermembranous clot in twins. MRI. MRI should be considered after negative ultrasound findings in the presence of late trimester bleeding.MRI accurately detects placental abruption. NON STRESS TEST. Fetal distress evidenced by late decelerations,fetalbradycardia and decreased beat to beat variability. LABORATORY STUDIES. *HB%, *ct,bt,pt,aPTT. *Blood group and RH type *S.fibrinogen levels <<<<200 mg/dlindicates severe abruption. *Kleihauer -betke test. TREATMENT AND PROGNOSIS. * Continuous feral monitoring. *IV access. *Crystalloid fluid replacement. *Type and cross match blood. *Correct coagulopathy.if present. *Administer The immune globulin if patient is The negative. *Vaginal delivery is the preferred method of delivery in intra uterine death. *Caesarean section is done for maternal and feral stabilisation. *In case of PPH , correct coagulopathy. Ligate uterine artery,give uterotonics . bleeding persistent,go for Caesarean hysterectomy. COMPLICATIONS OF ABRUPTIO. *SHOCK. *COAGULATION FAILURE. *RENAL FAILURE.

One young married woman came to OPD with pain in the abdomen. on examination it was corresponding to 22 wks pregnancy. she was pallor. scan was done iud of 2owks abruptio.placenta. pt was not aware that she was pregnant. she was pallor her Hb was 7.4gms. PT INR was slightly raised.p/V examination was ext is closed. immediately we Transfused one pint blood . one we reserve. we started two doses of mifipristone followed by misoprostol. 400mg first dose followed by 200 mg second dose. in the meanwhile two FFPS Transfused. she delivered atv6.30 pm next day. it was breech presentation. 500gm of clots expelled. One more blood Transfused after delivery.

Which of the following is true regarding the image below ? A. seen in obstructed labour B. It is an indication for hysterectomy C. It is a case of uteroplacental apoplexy D. It is observed in placenta percreta