PubMed · 6054121
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D M Haynes. 1967. Managing third trimester bleeding.. https://doi.org/10.1080/00325481.1967.11696305
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The diagnosis of abruptio placentae is based on clinical symptoms and the classical presentation seldom causes diagnostic doubt. There is no significant correlation between the presenting symptoms and degree of placental abruption. Additional diagnostic parameters would be useful in cases with few symptoms. The survey describes the clinical presentation and diagnosis. The use of paraclinical tests in diagnosing, monitoring and estimating prognosis in cases with suspicion of abruptio placentae is reviewed.
OBJECTIVE: Our aim was to evaluate prospectively the effects of cocaine and marijuana use on pregnancy outcomes. STUDY DESIGN: A prospective multicenter cohort study was conducted at seven university-based prenatal clinics in the United States from 1984 to 1989. The cohort described herein consisted of a multiethnic population of 7470 pregnant women. Information on the use of drugs was obtained from personal interviews at entry to the study and assays of serum obtained during pregnancy. Pregnancy outcome data (low birth weight [< 2500 gm], preterm birth [< 37 weeks' gestation], and abruptio placentae) were obtained with a standardized study protocol. RESULTS: A total of 2.3% of the women used cocaine and 11.0% used marijuana during pregnancy. Cocaine use was not associated with having a low-birth-weight infant (adjusted odds ratio 0.7, 95% confidence interval 0.4 to 1.3) or a preterm birth (1.3, 0.9 to 2.0). There was no association between short-term exposure to cocaine and preterm delivery (1.1, 0.3 to 4.0). However, cocaine use was strongly associated with abruptio placentae (adjusted odds ratio 4.2, 1.9 to 9.5). Marijuana use was not associated with low birth weight (1.1, 0.9 to 1.5), preterm delivery (1.1, 0.8 to 1.3) or abruptio placentae (1.3, 0.6 to 2.8). By comparison, 35% of the women smoked cigarettes during pregnancy, and cigarette smoking was positively associated with low birth weight (1.5, 1.2 to 1.8). CONCLUSIONS: In this population of women receiving prenatal care, cocaine use was uncommon and was not related to most adverse birth outcomes. Marijuana use was relatively common and was not related to adverse pregnancy outcomes. Tobacco is still the most commonly abused drug during pregnancy, 15% of all cases of low birth weight in this study could have been prevented if women did not smoke cigarettes during pregnancy.
We report a case of splenic rupture after cesarean delivery for abruptio placentae. The diagnosis was not suspected until a laparotomy was performed. Diagnosis and management were complicated by disseminated intravascular coagulation and renal failure. The importance of early diagnosis and management modalities are discussed.