Placental abruption Flashcards

1
Q

What is the pathogenesis of placental abruption?

A
  • rupture of spiral arterioles leads to bleeding hemorrhage in decidua basalis -> occurs in diseased vessels (like preeclampsia)
  • secondary to inflammation or infection
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2
Q

What are the risk factors for placental abruption?

A
  • chorioamnionitis
  • PROM
  • advanced maternal age
  • high parity
  • pre-eclampsia
  • chronic hypertension
  • polyhydramnios
  • multiple gestation
  • prior placental abruption
  • trauma
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3
Q

What is the clinical presentation of placental abruption?

A
  • sudden onset of abdominal pain, vaginal bleeding & uterine tenderness
  • back pain
  • severe bleeding could lead to shock
  • fetal distress
  • hypertonic uterus if it occurred during labour
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4
Q

When is placental abruption classified as severe?

A

1- maternal complications: DIC, shock, renal impairment, hysterectomy
2- fetal complications: non reassuring fetal heart tracing, fetal death
3- neonatal death

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5
Q

What are the maternal complications?

A

1- consumptive coagulopathy/DIC -> with massive bleeding -> give FFP
2- couvelaire uterus -> uterine atony
3- END organ damage -> hypovolemia & shock -> acute kidney injury
4- Sheehan’s syndrome = pituitary failure

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6
Q

What are the fetal complications with placental abruption?

A
  • fetal asphyxia
  • prematurity
  • fetal death
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7
Q

How is placental abruption diagnosed?

A
  • painful vaginal bleeding
  • US -> presence of retroplacental hematoma
  • MRI -> highly sensitive
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8
Q

How is placental abruption managed?

A

1- Resuscitation -> crystalloids, blood, blood products

2- expectant management
- preterm fetus
- stable
- can give tocolytic

3- Vaginal delivery
- dead fetus
- viable stable babies with normal fetal wellbeing test
- starts spontaneously or amniotomy can be done

4-emergency C section
- fetal compromise, viable fetus & vaginal delivery not imminent
- hemodynamic instability
- bleeding if DIC developed
- check platelet, Hb & clotting profile
- crossmatching of blood

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