Abstract
The premature separation of the normally implanted placenta is one of the main causes of the disseminated coagulation syndrome (DIC). The selection of treatment for the disease greatly affects the prognosis and, therefore, from this point of view, this disease possesses important gynecological sinificance.
Forty-seven cases of premature separation of the normally implanted placenta observed in the past 12 years were analyzed statistically. The incidence was found to be 0.49%. When the relation between the method of delivery and prognosis of the infant's development was considered, 28 cases (59.6%) were vaginal deliveries, 23 (82.1%) being live-births and 5 (17.9%) being still-births. On the other hand, 19 cases (40.4%) were delivered by cesarean section, 14 (73.7%) being live-births and 5 (263%) being still-births.
When the relation between complications of the mother and the condition of the babies was considered, severe toxemia of pregnancy was found in 7 cases (14.9%) and DIC in 6 (12.8%). Among the mothers suffering from DIC, 2 cases (33.8%) delivered live-births and 4 cases (66.7%) still-births. Forty-one did not suffer from DIC, 35(85.3%) having live-births and 6 (14.6%) still-births.
Four cases of DIC underwent a Porro operation, including one who suffered from premature separation of the normally implanted placenta. Occurrences of the mother's death were none. Melena was seen in 2 of the new-born babies.
In Japan, toxemia of pregnancy is considered to be one of the main causes of premature separation of the normally implanted placenta. However, recent observations revealed strong evidence to indicate that the premature separation of the normally implanted placenta is simply an accidental complication during the pregnancy. In addition, with regard to the mechanism by which DIC is induced during the premature separation, the influx of the serum components from the retroplacental hematoma into the maternal blood stream, influx of tissue thromboplastin from the site of placenta separation into the blood stream, or loss of blood coagulation factor are currently under consideration.
Treatments for the premature separation of the normally implanted placenta include treatment for bleeding, recovery of blood loss, shock and abnormality of blood coagulation. In addition, treatment for precipital labour and post-delivery complications should be included. However, the most important treatment for the premature separation of the normally implanted placenta is to correct the abnormality in blood coagulation, in particular hypofibrinogenemia (a period of lowered coagulating abillity), i. e. intravascular coagualtion (organic damage).
During DIC, a complication of the premature separation of the normally implanted placenta. the period of increased blood coagulation is often short. Therefore, most of the clinically encountered premature separations of normally implanted placentas are in the state of consumption coagulopathy and, thus, treatment with heparin is contraindicated.
