Placental Abruption Flashcards
Placental abruption
When the placenta separates from the wall of the uterus during pregnancy
The site of attachment can bleed extensively after the placenta separates
Complication of placental abruption
Antepartum haemorrhage
Risk factors for placental abruption
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
Sudden onset severe abdominal pain that is continuous
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension and tachycardia)
Abnormalities on the CTG indicating fetal distress
“woody” abdomen on palpation - large haemorrhage
Severity of Antepartum Haemorrhage
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
Concealed abruption
Where cervical os remains closed therefore any bleeding remains within the uterus
How to diagnose placental abruption
Clinical diagnosis - history and examination
USS - rule out placenta praevia
Management of placental abruption
Obstetric emergency
- A- E
- Urgent involvement of a senior obstetrician, midwife and anaesthetist
- 2 x grey cannula
- Bloods include FBC, UE, LFT and coagulation studies, G+S and crossmatch
- Crossmatch 4 units of blood
- Fluid and blood resuscitation as required
- CTG monitoring of the fetus
- Close monitoring of the mother - may need emergency Caesarean section
Corticosteroids between 24 - 36+6 weeks for preterm delivery
Anti rhesus D if required
(Kleihauer test used to quantify fetal blood for anti D dose)
Management of placental abruption after birth
High risk of postpartum haemorrhage therefore active management of the third stage
When would an emergency caesarean be done in placental abruption
If fetus is < 36 weeks
Fetal distress
Mother is unstable
