[SHOCK IN OBSTETRICS].
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We retrospectively analyzed the clinical significance of placental position in patients with placental abruption by comparing cases in which the placenta was implanted on the anterior wall of the uterus (n=17) and those in which the placenta was on the posterior wall (n=12). There were no significant differences in clinical features of patients or pregnancy outcomes between the two groups. In this study, all patients with an anterior-wall placenta received a diagnosis of placental abruption prenatally, whereas only 8 patients (67%, p=0.01) with posterior-wall placenta received a diagnosis of placental abruption prenatally. Serious consideration should be given to the diagnosis of placental abruption in patients with a posterior-wall placenta.
The instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrome can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis. This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.
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