Placenta Abruption

Question 1

Placenta abruption is when there is a disruption between the placenta and the uterus. What is the main cause of this disruption between the uterus and the placenta?

1 - infection
2 - haemorrhage
3 - sepsis
4 - UTI

Answer 1

2 - haemorrhage
- the blood collects between the uterus and the placenta
- vascular structures supporting the placenta are compromised

Question 2

Placenta abruption is when there is a disruption between the placenta and the uterus. Typically this is caused by haemorrhage between the uterus and the placenta. How many types of placenta abruption are there?

1 - 6
2 - 4
3 - 3
4 - 2

Answer 2

3 - 3
- revealed placenta abruption
- concealed placenta abruption
- mix of revealed and concealed

Question 3

What is the mean age for placenta abruption?

1 - 16-25
2 - 20-30
3 - 30-40
4 - 40-50

Answer 3

3 - 30-40

Question 4

Placenta abruption is when there is a disruption between the placenta and the uterus. Typically this is caused by haemorrhage between the uterus and the placenta. What is the incidence of placenta abruption in the UK?

1 - 0.1%
2 - 1%
3 - 10%
4 - 30%

Answer 4

2 - 1%

Question 5

Does vaginal bleeding due to placenta abruption typically occur in the 1st o2 2nd half of pregnancy?

Answer 5

• 2nd half of pregnancy

Question 6

Although the exact cause of placenta abruption is unknown, there are risk factors associated with it. Which of the following is NOT a risk factor?

1 - previous abruption
2 - nulliparity
3 - age
4 - pre-eclampasia or maternal hypertension
5 - abdominal trauma
6 - cigarette / cocaine / alcohol
7 - low socioeconomic group
8 - external cephalic version

Answer 6

2 - nulliparity
- multiparty is a risk factor

External cephalic version = manoeuvre by doctor is baby is in breech position

Question 7

Chorioamnionitis can cause placenta abruption. What is this?

1 - sampling of the amniotic fluid interferes with blood supply
2 - macrosomnia baby
3 - intraamniotic infection affecting amniotic sac and membranes
4 - polyhydramnios

Answer 7

3 - intraamniotic infection affecting amniotic sac and membranes

Question 8

When performing a history on the patient which 2 of the following are key to identifying a patient with placenta abruption?

1 - painless pelvic/abdomen
2 - mass in abdomen
3 - unprovoked continuous abdominal pain
4 - vaginal bleeding

Answer 8

3 - unprovoked continuous abdominal pain
4 - vaginal bleeding

• uterine contractions may be present as well

Question 9

In a patient with placenta abruption unprovoked abdominal pain is a tell tale clinical symptom. Is there always vaginal bleeding?

Answer 9

• no
• concealed placenta abruption, where blood collects in the uterus
• patients shock appears out of proportion to symptoms

Question 10

Which of the following conditions, which is associated with placenta abruption may present with headaches, vision changes, oedema, hyper reflexia, epigastric pain. proteinuria and nausea?

1 - pre-eclampsia
2 - obstetric cholestasis
3 - antepartum haemorrhage
4 - pulmonary embolism

Answer 10

1 - pre-eclampsia

• urinalysis should be done on patients if possible to assess for proteinuria and protein : creatinine ratios

Question 11

In a patient with placenta abruption which of the following would NOT typically be present upon examination?

1 - soft and non-tender uterus
2 - rapid maternal pulse
3 - low BP
4 - tender uterus

Answer 11

1 - soft and non-tender uterus
- uterus would typically be hard (woody feeling) due to haemorrhage and uterine contractions, if present

Question 12

Which of the following is NOT a realistic differentials, except for placenta abruption, in a patient who presents with vaginal bleeding, abdominal pain, hard uterus and some signs of shock (BP and HR changes)?

1 - Chorioamnionitis
2 - Pre term labour
3 - Uterine fibroid degeneration
4 - Endometriosis

Answer 12

4 - Endometriosis

Question 13

If placenta previa has been excluded, is a digital examination still contraindicated?

Answer 13

• no
• this will help identify if the patient has began labour

Question 14

Which tests must be performed in a patient with placenta abruption and risk of bleeding?

1 - FBC
2 - coagulation profile
3 - group and save and crossmatch
4 - rhesus status
5 - all of the above

Answer 14

5 - all of the above

Question 15

What tells the doctor that the baby is ok if there is bleeding in placenta abruption?

1 - ultrasound
2 - maternal feeling of movement
3 - CTG
4 - all of the above

Answer 15

4 - all of the above

Question 16

What test can be used to assess for the presence of foetal blood in maternal circulation, which can occur during haemorrhage and affects Rhesus status?

1 - FBC
2 - Kleihauer test
3 - blood smears
4 - blood cross matching

Answer 16

2 - Kleihauer test

Question 17

Why should renal function be assessed in individuals with placenta abruption?

1 - risk of hypovolaemia
2 - risk of polyhidrosis
3 - risk of pyelonephritis
4 - all of the above

Answer 17

1 - risk of hypovolaemia
- will see low urine output and drop in BP due to excessive blood loss, cause kidney injury
- if concealed placenta abruption then blood loss may not be obvious

Question 18

If there is maternal or foetal compromise when the mother begins to bleed, what should occur asap in placenta abruption?

1 - vaginal birth
2 - abortion to save the mother
3 - c-section
4 - any of the above

Answer 18

3 - c-section

Question 19

Is a c-section required in all patients with placenta abruption?

Answer 19

• no
• if baby becomes engaged and head passed edge of placenta, vaginal birth may be necessary

Question 20

What is the major maternal risk factor in a patient with placenta abruption?

1 - sepsis
2 - post-partum haemorrhage
3 - uterine rupture
4 - UTI

Answer 20

2 - post-partum haemorrhage
- lower uterus does not contract as well, therefore venous sinuses are not as efficiently occluded
- 25% of cases experience post-partum haemorrhage

Question 21

Placenta abruption which causes post-partum haemorrhage can lead to Sheehan syndrome. What is this?

1 - necrosis of pituitary gland due to blood loss
2 - necrosis of hypothalamus due to blood loss
3 - necrosis of adrenal gland due to blood loss
4 - liver necrosis due to blood loss

Answer 21

1 - necrosis of pituitary gland due to blood loss

Question 22

In a patient with placenta previa, they may need to deliver earlier than planned if they experience vaginal bleeding. The mother may be given corticosteroids to help develop the foetus lungs. Below what week of gestation should corticosteroids be given if the baby needs to be delievred?

1 - <38 weeks
2 - <37 weeks
3 - <35 weeks
4 - <34 weeks

Answer 22

4 - <34 weeks

Question 23

Pregnant women who has develop vaginal bleeding with placenta abruption and who are rhesus negative should be given anti-D within what time frame from the onset of bleeding?

1 - <12 hours
2 - <48 hours
3 - <72 hours
4 - <120 hours

Answer 23

3 - <72 hours