Placental Abruption

Question 1

Define placental abruption

Answer 1

The placenta separates partly or completely from the uterus before delivery of the foetus

Question 2

What is the difference between revealed, concealed, and mixed placental abruption

Answer 2

Revealed: blood tracks between the membranes and appears as vaginal bleeding
Concealed: blood tracks between the membranes, but there is no PV bleeding
Mixed: the PV bleeding detected does not reflect the true extent of the intrauterine bleeding

Question 3

What are the risk factors for placental abruption

Answer 3

Multiple pregnancy
Abdominal trauma
Recreational drug use, especially cocaine
IUGR
Low BMI
Older maternal age
Pre-eclampsia or chronic HTN

Question 4

What are the symptoms of placental abruption

Answer 4

Severe abdominal pain
PV bleeding
Lower back pain
High-frequency, low-amplitude uterine contractions occur commonly in abruption (women are usually in labour)

Question 5

What are the signs of placental abruption on examination

Answer 5

Obs: hypotension and tachycardia

Abdominal exam: tense (Woody), tender uterus

Question 6

What investigations should be done for placental abruption

Answer 6

Clinical diagnosis

Bloods: FBC, G&S, cross match, U&Es, Klleihaier betke test, coagulation screen
Other: CTG - monitor for foetal distress

(US can be used to exclude placenta praevia, difficult to pick up abruption)

Question 7

What CTG findings suggest a placental abruption

Answer 7

Late decelerations
Loss of variability
Variable deceleration
A sinusoidal foetal heart rate tracing
Foetal bradycardia (Persistent HR <110bpm)

Question 8

Management of placental abruption

Answer 8

<36 weeks
Distress: Immediate caesarean
Stable: observe closely, administer steroids (<34w), consider delivery depending on gestation (tocolysis CI)

> 36 weeks
Distress: immediate caesarean
Stable: Deliver vaginally if possible

+ neonatal support
+ Anti-D Ig for non-sensitised RhD -ve women
+ thromboprophylaxis (TED stockings, unfractionated heparin)

Foetus dead
Induce vaginal delivery

Question 9

What are the complications of placental abruption

Answer 9

Maternal: shock, DIC, renal failure, PPH
Foetal: IUGR, hypoxia, death, perinatal asphyxia, long-term neurodevelopmental handicap

Risk of preterm birth, placental abruption, pre-eclampsia in subsequent births

Question 10

What is the prognosis of placental abruption

Answer 10

High perinatal mortality rate, especially if more than 50% separation
Perinatal outcome may be good in cases where abruption is recognised promptly and the foetus is delivered
Outcome excellent where there is massive blood loss or coagulopathy