Placental abruption

Question 1

Placental abruption

Answer 1

Separation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into intervening space

Question 2

Associated factors

Answer 2

Proteinuric HTN

Cocaine use

Multiparity

Maternal trauma

Increasing maternal age

Question 3

Clinical features

Answer 3

Shock out of keeping with visible loss

Pain constant

Tender, tense uterus

Normal lie and presentation

Fetal heart: absent/ distressed

Coagulation problems

Beware pre-eclampsia, DIC, anuria

Question 4

Management if fetus alive <36 weeks

Answer 4

Fetal distress: immediate c-section

No fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Question 5

Fetus alive and >36 weeks

Answer 5

Fetal distress: immediate c-section

No fetal distress: deliver vaginally

Question 6

Maternal complications

Answer 6

Shock

DIC

Renal failure

PPH

Question 7

Fetal complications

Answer 7

IUGR

Hypoxia

Death

Question 8

Prognosis

Answer 8

Associated with high perinatal mortality rate

Responsible for 15% of perinatal deaths