Placental abruption

Question 1

What is placental abruption?

Answer 1

Where a part or all of the placenta separates from the wall of the uterus prematurely

Question 2

What is placental abruption an important cause of?

Answer 2

Antepartum haemorrhage

Question 3

What is antepartum haemorrhage?

Answer 3

Bleeding from 24 weeks gestation until delivery

Question 4

How does abruption occur?

Answer 4

Following a rupture of maternal vessels within the basal layer of the endometrium
Blood accumulates and splits the placental attachment from the basal layer
The detached portion of the placenta is unable to function, leading to rapid foetal compromise

Question 5

Name the two types of placental abruption

Answer 5

Revealed

Concealed

Question 6

Describe revealed placental abruption

Answer 6

Bleeding tracks down from the site of placental separation and drains through the cervix. Results in vaginal bleeding

Question 7

Describe concealed placental abruption

Answer 7

Bleeding remains within the uterus and typically forms a clot retro placentally
Bleeding is not visible but can be severe enough to cause systemic shock

Question 8

List the risk factors for placental abruption

Answer 8

Placental abruption in previous pregnancy 
Pre-eclampsia and other HTN disorders
Abnormal lie of the baby 
Polyhydramnios
Abdominal trauma 
Smoking or drug use 
Bleeding in 1st trimester 
Underlying thrombophilia
Multiple pregnancy

Question 9

List the clinical features of placental abruption

Answer 9

Antepartum haemorrhage - painful vaginal bleeding

If in labour - enquire about contractions

Question 10

Describe the examination findings in placental abruption

Answer 10

Woody uterus (tense all the time) and painful on palpation

Question 11

List the differentials of placental abruption

Answer 11

Placenta praevia
Marginal placental bleed
Vasa praevia
Uterine rupture 
Local genital causes - benign or malignant lesions and infections

Question 12

What investigations do you do for placental abruption?

Answer 12

FBC, clotting, Kleihauer test, Group and safe, cross match if presentation warrants transfusion, U&Es, LFTs
Assess foetal wellbeing - >26 weeks gestation do a CTG
USS if patient stable

Question 13

What might be seen on USS in placental abruption?

Answer 13

Retroplacental haematoma

Question 14

Describe the management of placental abruption

Answer 14

ABCDE approach
Emergency delivery - C-section unless spontaneous delivery is imminent or operative vaginal birth achievable

Induction of labour - avoid further bleeding

Conservative management if not associated with foetal or maternal compromise