Antenatal Care - Placental Abruption

Question 1

What is Placental Abruption?

Answer 1

The placenta separates from the wall of the uterus during pregnancy - the site of attachment can bleed extensively after the placenta separates.

Question 2

Risk Factors of Placental Abruption.

Answer 2

1. Previous Placental Abruption.
2. PET.
3. Bleeding Early in Pregnancy.
4. Trauma.
5. Multiple pregnancy.
6. Multigravida.
7. FGR.
8. Increased Maternal Age.
9. Smoking, Cocaine, Amphetamine.

Question 3

What is Concealed Abruption?

Answer 3

The cervical os remains closed - any bleeding that occurs remains within the uterine cavity; severity can be underestimated.

Question 4

Clinical Presentation of Placental Abruption (4).

Answer 4

1. Sudden-Onset Severe Abdominal Pain - CONTINUOUS.
2. Vaginal Bleeding (APH).
3. Shock.
4. CTG Abnormalities : Foetal Distress.

Question 5

Examination Finding of Placental Abruption.

Answer 5

WOODY Abdomen on Palpation = large haemorrhage.

Question 6

Investigations of Placental Abruption.

Answer 6

1. Clinical Diagnosis.

2. Exclude Placenta Praevia using US.

Question 7

Immediate Management of Placental Abruption.

Answer 7

OBSTETRIC EMERGENCY :

1. Urgent Involvement of a Senior Obstetrician, Midwife and Anaesthetist.
2. 2x Grey Cannulae.
3. Bloods.
4. Crossmatch 4 Units of Blood.
5. Fluid/Blood Resuscitation.
6. CTG Monitoring and Monitoring of Mother.

Question 8

Management of Placental Abruption.

Answer 8

1. Antenatal Steroids Between 24 and 34+6 Weeks.
2. Anti-D Prophylaxis in Rhesus-D Negative Women (with Kleihauer Test).
3. Emergency C-Section (Unstable Mother, Foetal Distress).
4. Active Management of 3rd Stage of Labour.

Question 9

Management of Placental Abruption with Alive Foetus Before Week 36.

Answer 9

1. Foetal Distress : Immediate C-Section.

2. No Foetal Distress : Observation, Steroids, No Tocolysis.

Question 10

Management of Placental Abruption with Alive Foetus After Week 36.

Answer 10

1. Foetal Distress : Immediate C-Section.

2. No Foetal Distress : Deliver Vaginally.

Question 11

Complications of Placental Abruption (6).

Answer 11

1. Antepartum Haemorrhage.
2. PPH.
3. Shock.
4. DIC.
5. Renal Failure.
6. Foetal Complications : IUGR, Hypoxia, Death.

Question 12

Severity of Antepartum Haemorrhage (4).

Answer 12

1. Spotting.
2. Minor Haemorrhage (Below 50ml).
3. Major Haemorrhage (50-1000ml).
4. Massive Haemorrhage (1000ml+).