Placental abruption

Question 1

What is placental abruption?

Answer 1

Where the placenta detaches from the wall of the uterus during pregnancy

Question 2

What are the risk factors for placental abruption?

Answer 2

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking

Question 3

What is the presentation of placental abruption?

Answer 3

Sudden onset of severe continuous abdominal pain
Vaginal bleeding
Shock
Abnormalities on CTG indicating fetal distress
‘Woody’ abdomen on palpation

Question 4

What is concealed abruption?

Answer 4

Where the cervical os remains closed, and so bleeding is contained with the uterine cavity

Question 5

What is the general management of placental abruption?

Answer 5

Haemorrhage protocol:
- Involve seniors and anaethetist
- 2x grey cannula
- FBC, U&E, LFTs, coagulation studies
- Crossmatch 4 units of blood
- Fluid and blood resuscitation as required
- CTG monitoring of fetus

Question 6

What are the differentials of placental abruption?

Answer 6

Preterm labour
Placenta praevia
Chorioamnionitis
UTI
Degeneration of uterine fibroids
Acute appendicitis

Question 7

What is the management of placental abruption at less than 36 weeks?

Answer 7

If fetal distress - immediate caesarean
No fetal distress - administer steroids and observe

Question 8

What is the management of placental abruption after 36 weeks?

Answer 8

If fetal distress - immediate caesarean
No fetal distress - delivery vaginally