Placental abruption

Question 1

Define placental abruption.

Answer 1

The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus.

Question 2

What is the aetiology of placental abruption?

Answer 2

Abruption may result from a variety of different pathways.

• Direct abdominal trauma may cause separation of the placenta.
• Indirect trauma may shear the placenta off the uterine wall.
• Cocaine use causes vasospasm that may lead to placental separation.

Exact aetiology is unknown but evidence shows that it is a chronic process.

Question 3

What are risk factors for placental abruption?

Answer 3

Chronic hypertension

Pre-eclampsia

Smoking

Cocaine use

Trauma

Chorioamnionitis

Uterine malformations

Prior placental abruption

Oligohydramnios

PPROM

Multiparity

Advanced maternal age

Polyhydramnios

Question 4

Summarise the epidemiology of placental abruption.

Answer 4

Placental abruption complicates about 0.3% to 1% of births.

Question 5

What are some signs and symptoms of placental abruption?

Answer 5

Vaginal bleeding

Abdominal pain

Uterine contractions

Uterine tenderness

Question 6

What are some investigations performed for placental abruption?

Answer 6

Fetal monitoring

Hb and Hct

Coagulation studies

USS

Kleihauer-Betke (K-B) test - Test if there is fetal blood in maternal blood, usually negative

Question 7

What is the management for placental abruption?

Answer 7

IV access with large bore cannula

Basic obs and CTG

Anti-D immunoglobulin in Rh-negative women.

Fluid, antifibrinolytics, blood, or blood-product replacement, as indicated.

Sonographic examination for placental location and for evidence of abruption. Placenta praevia found on sonography makes placental abruption unlikely.

Aim for vaginal delivery if >34 weeks, if <34 weeks, give corticosteroids and aim for delivery

Question 8

What are some complications associated with placental abruption?

Answer 8

Hypovolaemic shock

Disseminated intravascular coagulation

IUGR

Neurological impairment in the infant

Preterm birth

Perinatal death

Acute renal failure

Question 9

What is the prognosis for placental abruption?

Answer 9

Cases of extremely preterm gestations and those with more than 50% separation of the placenta are associated with a high risk of perinatal death. Due to aphyxia, can also result in neurological delay and handicap. If baby is delivered quickly and abruption is diagnosed rapidly then prognosis is good.

Maternal outcomes are excellent in cases in which there is neither massive blood loss nor coagulopathy.