Placental Abruption Flashcards
What is placental abruption?
Placental abruption refers to when the placenta separates from the wall of the uterus during pregnancy. The site of attachment can bleed extensively after the placenta separates. Placental abruption is a significant cause of antepartum haemorrhage.
What are the risk factors for placental abruption?
The risk factors for placental abruption are:
- Previous placental abruption
- Pre-eclampsia
- Bleeding early in pregnancy
- Trauma (consider domestic violence)
- Multiple pregnancy
- Fetal growth restriction
- Multigravida
- Increased maternal age
- Smoking
- Cocaine or amphetamine use
How does placental abruption present?
The typical presentation of placental abruption is with:
- Sudden onset severe abdominal pain that is continuous
- Vaginal bleeding (antepartum haemorrhage)
- Shock (hypotension and tachycardia)
- Abnormalities on the CTG indicating fetal distress
- Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage
How is the severity of placental abruption graded?
The RCOG guideline (2011) defines the severity of antepartum haemorrhage as:
- Spotting: spots of blood noticed on underwear
- Minor haemorrhage: less than 50ml blood loss
- Major haemorrhage: 50-1000ml blood loss
- Massive haemorrhage: more than 1000 ml blood loss, or signs of shock
What is a concealed abruption?
Concealed abruption is where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity. The severity of bleeding can be significantly underestimated with concealed haemorrhage.
Concealed abruption is opposed to revealed abruption, where the blood loss is observed via the vagina.
How is placental abruption diagnosed?
There are no reliable tests for diagnosing placental abruption. It is a clinical diagnosis based on the presentation.
What is the initial management of placental abruption?
The initial steps with major or massive haemorrhage are:
- Urgent involvement of a senior obstetrician, midwife and anaesthetist
- 2x grey cannula
- Bloods include FBC, UE, LFT and coagulation studies
- Crossmatch 4 units of blood
- Fluid and blood resuscitation as required
- CTG monitoring of the fetus
- Close monitoring of the mother
What is the role of ultrasound?
Ultrasound can be useful in excluding placenta praevia as a cause for antepartum haemorrhage but is not very good at diagnosing or assessing abruption.
What is the role of antenatal steroids?
Antenatal steroids are offered between 24 and 34 + 6 weeks gestation to mature the fetal lungs in anticipation of preterm delivery.
What is the role of anti-D prophylaxis?
Rhesus-D negative women require anti-D prophylaxis when bleeding occurs. A Kleihauer test is used to quantify how much fetal blood is mixed with the maternal blood, to determine the dose of anti-D that is required.
When may an emergency section be required?
Emergency caesarean section may be required where the mother is unstable or there is fetal distress.
Why is active management of the third stage recommended in placental abruption?
There is an increased risk of postpartum haemorrhage after delivery in women with placental abruption. Active management of the third stage is recommended.
