Placental abruption Flashcards
what is placental abruption?
the placenta detaches from the uterus slightly during pregnancy
the basic cause of placental abruption is
deterioration of the maternal blood vessels supplying the placenta
risk factors for placental abruption
pre-eclampsia
cocaine
amphetamine
trauma
multiple pregnancy
smoking
increased maternal age
multigravida
pain in placental abruption
udden onset constant pain
examination of the abdomen in placental abruption
woody hard abdomen
suggest why severity of shock may be disproportionate to loss of blood in placental abruption (2)
there is often a pocket of blood inside the uterus
the cervical os may remain closed
what is a “concealed abruption”?
the cervical os remains closed and any bleeding that occurs remains inside the uterine cavity
how is placental abruption diagnosed?
clinically
how useful is USS in the diagnosis of abruption?
generally it is not very reliable - it may however be used to check for a placenta praevia
management of birth when there is a placental abruption
prepare for premature birth i.e. give steroids
emergency caesarean if there are signs of foetal distress or of maternal shock
active management of the third stage
is placental abruption a sensitising event?
yes
how can the risk of PPH be reduced in placental abruption?
active management of the third stage reduces the risk of PPH
in which situation would a patient with a placental abruption be induced for vaginal labour?
if there is no foetal distress and the pregnancy is 36 weeks gestation or above
should be avoided in patients with placental abruption if their pregnancy is <36 weeks and there is no foetal distress
tocolysis (i.e. the process of halting contractions)
you want the baby to deliver!
management of placental abruption when the foetus has died
induce vaginal delivery
