Placental Abruption

Question 1

Definition

Answer 1

Partial or complete detachment of the placenta prior to foetal delivery

Question 2

Sher Classification

Answer 2

Either concealed (no obvious bleeding) or revealed (APH)

• Stage One: mild, retrospective DX of PPH
• Stage Two: Intermediate, hypertonic uterus + delivery of live foetus
• Stage Three: Severe, intrauterine foetal death (A without coagulopathy B with)

Question 3

RFx for Abruption

Answer 3

Medical
Amphetamine or cocaine use
HTN
Thrombophilia
Smoking
Maternal age (<20 or >35yrs)

Obstetric
Previous c section
Parity >3
Previous Abruption
Previous IUGR.
Pre eclampsia
IUGR
Preterm rupture of membranes

Question 4

Clinical Features of Abruption

Answer 4

Chronic
- asymptomatic
- intermittent vaginal bleeding

Acute
- asymptomatic
- back and abdominal pain
- APH
- Quick labour with hypertonic uterus

Question 5

Diagnosis of Abruption

Answer 5

Primarily a clinical diagnosis - often under diagnosed and under estimated blood loss
Abdo pain + hypertonic uterus +/- APH +/- Haemodynamic compromise
USS- specific (96%) but not sensitive (24%)

Question 6

Principles of MOH management

Answer 6

• Replace circulating volume and oxygen-carrying capacity
• Correct coagulopathy
• Prevent complications of blood transfusion

Question 7

Fibrinogen in pregnancy

Answer 7

Maternal Fibrinogen 4-6g/L
Non-pregnancy 2-4g/L
Reduces rapidly in MOH compared to plts and clotting factors
Give Cryo (15g/L) over FFP (2g/L)