Placental Abruption

Question 0

Fetomaternal hemorrhage?

Answer 0

Fetal blood enters maternal circulation

Question 1

Concealed abruption?

Answer 1

Placental abruption in which bleeding occurs completely behind the placenta (no external bleeding)

Question 2

Couvelaire uterus? Visible sign.

Answer 2

Bleeding into the myometrium of the uterus from placental abruption

Results in discolored (reddish) appearance to the uterine surface

Question 3

Placental abruption: suggestive signs upon delivery? Post delivery?

Answer 3

Blood clot adhering to placenta

Uterine atony, postpartum hemorrhage

Question 4

Coagulopathy in placental abruption secondary to? Not encountered unless?

Answer 4

Hypofibrinogenemia; level less than 150

Question 5

Risk factors for placental abruption?

Answer 5

1. Hypertension
2. Drugs - Smoking, Cocaine
3. Short umbilical cord
4. Trauma (Motor vehicle accident)
5. Uterine problems - Uteroplacental insufficiency, Submucosal leiomyoma, Uterine decompression,
6. Preterm premature rupture of membranes

Question 6

Clinical features that are suggestive of placental abruption?

Answer 6

1. Painful vaginal bleeding (homework)
2. Preterm labor
3. Stillbirth
4. Fetal heart rate abnormalities

Question 7

Lab suggestive of placental abruption? Specific test?

Answer 7

Fetal erythrocytes in maternal blood

Kleihauer-Betke test – exploits difference in solubilities of normal and fetal hemoglobin to measure fetal erythrocytes in maternal blood

Question 8

Management? Describe labor?

Answer 8

Delivery

Very rapid

Question 9

Patients with placental abruption that are given fluids may manifest with what symptoms? Management?

Answer 9

1. Hypertension

2. Preeclampsia (Magnesium sulfate)