Placental Abruption Flashcards
Definition of placental abruption
Partial or complete detachment of the placenta prior to foetal delivery
Sher Classification of placental abruption
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)
RFx for Abruption
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
Clinical Features of Abruption
Chronic
- asymptomatic
- intermittent vaginal bleeding
Acute
- asymptomatic
- back and abdominal pain
- APH
- Quick labour with hypertonic uterus
Diagnosis of Abruption
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%)
Principles of MOH management
- Replace circulating volume and oxygen-carrying capacity
- Correct coagulopathy
- Prevent complications of blood transfusion
Fibrinogen in pregnancy
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)