placental abruption

Question 1

definition

Answer 1

Placental abruption refers to when the placenta separates from the wall of the uterus during pregnancy leading to antepartum haemorrhage

Question 1

risk factors

Answer 1

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use

Question 2

presentation

Answer 2

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 3

Severity of antepartum haemorrhage

Answer 3

Spotting: spots of blood noticed on underwear
Minor haemorrhage: less than 50ml blood loss
Major haemorrhage: 50 – 1000ml blood loss
Massive haemorrhage: more than 1000 ml blood loss, or signs of shock

Question 4

concealed vs revealed haemorrhage

Answer 4

concealed : closed cervical os
revealed : vaginal bleeding

Question 5

management of placental abruption < 36 weeks

Answer 5

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

Question 6

management of placental abruption > 36 weeks

Answer 6

fetal distress: immediate caesarean
no fetal distress: deliver vaginally

Question 7

Maternal complications of placental abruption

Answer 7

Maternal
shock
DIC
renal failure
PPH

Question 8

foetal complications of placental abruption

Answer 8

Fetal
IUGR
hypoxia
death