Placental Abruption Flashcards

1
Q

Define Placental Abruption.

A

Separation of the placenta from the uterine wall before delivery over >24 weeks

  • If <24w = miscarriage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for placental abruption?

A
  • HTN
  • Previous APH
  • PPROM
  • Abdominal trauma
  • Smoking
  • Cocaine
  • Polyhydramnios

70% occur in low-risk pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the signs and symptoms of placental abruption?

A
  • Constant abdominal pain ± PV bleeding
    • If revealed - 80%, 20% are concealed
  • Sustained contractions
  • On examination:
    • General – shock Abdomen – hypertonic “woody” tender uterus
    • Speculum – assess bleeding
    • Vaginal exam (NOT in praevia) – cervical dilatation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the appropriate investigations for suspected placental abruption?

A
  • Bloods – FBC, clotting, U&E, crossmatch
  • USS – exclude praevia – abruption unlikely to be present unless very large
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the management of placental abruption?

A
  • Mild
    • Preterm and stable = Conservative management with close monitoring with IOL at term
      • Admit for at least 48 hours or until bleeding stops
      • Anti-D Ig followed by Kleihauer test
  • Severe
    • ABC assessment, 2 wide bore cannulae, fluids, bloods, correct coagulopathies
    • Emergency CS
    • Bloods - FBC, G&S, crossmatch, Kleihauer test
    • Steroids to mature babies lungs (<35 weeks)
    • CTG (if >27w) → consider IOL if foetal compromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the complications of placental abruption?

A
  • Maternal
    • Haemorrhage - APH, PPH
    • DIC
    • Renal failure
    • “Couvelaire uterus” - extravasation of blood into myometrium and beneath the peritoneum → very hard uterus
  • Foetal
    • Birth asphyxia
    • Death
  • Prognosis
    • Maternal = 0.5% mortality in severe abruption
    • Foetal – 3.3% mortality in severe abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a Couvelaire uterus?

What is the sign of placental abruption?

A

Extravasation of blood into myometrium and beneath the peritoneum

Very hard uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly