Antenatal Care - Placental Abruption

Question 1

What is Placental Abruption?

Answer 1

The placenta separates from the wall of the uterus during pregnancy, causing the site of attachment to bleed extensively after separation - a cause of APH.

Question 2

Risk Factors of Placental Abruption (9).

Answer 2

1. Previous Placental Abruption.
2. Pre-Eclampsia.
3. Bleeding Early in Pregnancy.
4. Trauma / Domestic Violence.
5. Multigravidity.
6. Multiple Pregnancy.
7. Increased Maternal Age.
8. Smoking / Cocaine-Amphetamine Use.
9. FGR.

Question 3

Clinical Presentation of Placental Abruption (5).

Answer 3

1. Sudden Onset CONTINUOUS Severe Abdominal Pain.
2. Vaginal Bleeding (APH).
3. Hypovolaemic Shock.
4. CTG Abnormalities - Foetal Distress.
5. WOODY Abdomen on Palpation : Large Haemorrhage.

Question 4

Severity of APH (4).

Answer 4

1. Spotting - Spots of Blood on Underwear.
2. Minor Haemorrhage - Less than 50ml Blood Loss.
3. Major Haemorrhage - 50-1000ml Blood Loss.
4. Massive Haemorrhage - 1000+ml Blood Loss or Signs of Shock.

Question 5

What is Concealed Abruption?

Answer 5

The cervical os remains closed so any bleeding remains within the uterine cavity (underestimating of haemorrhage).

Question 6

Diagnosis of Placental Abruption.

Answer 6

Clinical Diagnosis.

Question 7

Management of Obstetric Emergency (8).

Answer 7

1. Urgent Involvement of Senior Obstetrician, Midwife and Anaesthetist.
2. 2x Grey Large-Bore Cannulae.
3. Bloods : FBC, U&Es, LFTs, Coagulation.
4. Crossmatch 4 Units of Blood.
5. Fluid and Blood Resuscitation.
6. CTG and Monitoring of Mother.
7. Kleinbauer Test and Rhesus D Prophylaxis : Negative.
8. Emergency C-Section.