Placental Abruption

Question 1

Associated factors with placental abruption?

Answer 1

COCAINE
Pre-eclampsia
Multiparity
Maternal trauma
Increasing age

Question 2

Frequency of placental abruption

Answer 2

1 in 200 pregnancies

Question 3

How would it present?

Answer 3

PAINFUL vaginal bleeding
Abdo pain
Tense, tender uterus

Question 4

How would you manage a placental abruption?

Answer 4

ABCDE approach

• IV access
• Bloods (FBC, Rhesus status, X match, clotting screen)
• Continuous foetal monitoring (24hr CTG)
• Fluids, TXA, blood, blood-product replacement as needed

Anti-D immunoglobulin in Rhesus negative women

Decide how/when to deliver:

• Mother haemodynamically unstable/foetal distress = Category 1 C-section regardless of gestation
• Haemodynamically stable + no foetal distress:
  >37wks = Induce
  <37wks = Admit to antenatal ward for IM steroids + monitoring (if bleeding settles consider discharge + weekly growth scans until birth)

Question 5

Counsel a patient who has presented to ED with placental abruption

Answer 5

Placental abruption = your placenta has seperated from the wall of the uterus, causing bleeding and pain.