8.21 Placental Abruption

Question 1

What is placental abruption?

Answer 1

separation of the placenta from the walls of the uterus during pregancy
(bleeds a lot, APH)

Question 2

What are some risk factors for placental abruption?

Answer 2

• Previous placental abruption
• Pre-eclampsia
• Bleeding early in pregnancy
• Trauma (consider domestic violence)
• Multiple pregnancy
• FGR
• Multigravida
• Increased maternal age
• Smoking
• COCAINE or amphetamine use

Question 3

What are the RCOG definitions for severity of APH?

Answer 3

Spotting: spots of blood noticed on underwear

<50ml = minor haemorrhage

50 – 1000ml = major haemorrhage

> 1000 ml or signs of shock = massive haemorrhage

Question 4

What is the presentation of placental abruption?

Answer 4

• sudden abdo pain that is CONTINUOUS
• “woody” abdo on palpation
• vaginal bleeding
• shock
• abnormal CTG

Question 5

What is a concealed abruption?

Answer 5

cervial os remains closed - bleeding remains in uterine cavity (blood loss is severely underestimated)

(vs revealed abruption)

Question 6

What are the steps for initial management of major or massive haemorrhage?

Answer 6

• Urgent involvement of a senior obstetrician, midwife and anaesthetist
• 2 x grey cannula
• Bloods include FBC, UE, LFT and coagulation studies
• Crossmatch 4 units of blood
• Fluid and blood resuscitation as required
• CTG monitoring of the fetus
• Close monitoring of the mother

Question 7

What can you give mum in a placental abruption? (beyond APH management)

Answer 7

antenatal steroids between 24 and 34+6 weeks for fetal lungs

antiD prophylaxis is she’s Rh-ve –> use Kleihauer test to quantify amount of fetal blood

emergency c-section if unstable

active management of 3rd stage

(clinical Dx but US can help exclude placenta previa)