32. Placental abruption Flashcards
what is placental abruption?
Premature separation of a normally implanted placenta from the uterine wall, resulting in hemorrhage between the uterine wall and the placenta.
what are the types of placental abruption?
Complete abruption vs. Partial abruption. - Concealed bleeding vs. Apparent (revealed) bleeding.
how does placental abruption present
Acute-onset, painful, 3rd trimester bleeding; usually associated with abdominal or back pain, and uterine contractions (uterine tone ↑).
Rapid progression into life-threatening bleeding, DIC (10-20% of cases), or fetal distress.
**In concealed abruption, patients usually present with preterm labor and no or minimal bleeding.
risk factors for placental abruption
Previous abruption
Abdominal trauma
HTN disorders of pregnancy
Cocaine use
Smoking
Uterine anomalies
PROM
HELLP syndrome
diagnosis of placental abruption
US → retroplacental hematoma.
Fetal heart rate tracing.
Labs → CBC, coagulation studies.
In all patients → hemodynamic monitoring and control, correction of coagulopathy,
continuous fetal monitoring with CTG.
- Both mother and fetus stable → expectant management (aim for delivery at 34-36 w’).
- Dead fetus → vaginal delivery by induction.
- Non-reassuring fetal heart rate tracing or Hemodynamically unstable mother → emergency cesarean delivery.
- Hemodynamically unstable mother → emergency cesarean delivery.
complications of placental abruption
- DIC (seen in 10-20% of cases of severe abruption).
- Hypovolemic shock and AKI as a result of massive bleeding.
- Sheehan syndrome (maternal postpartum pituitary necrosis).
difference in presentation between placental abruption and placenta previa
abruption- acute onset, painful, 3rd trimester bleeding (partial)
previa-painlees 3rd trimester bleeding
during initial evaluation of bleeding with abdominal palpation, what would be the difference between placental abruption and previa?
tone ↑ in abruption, tone ↓ in previa
