Placental abruption Flashcards
1
Q
Definition
A
Part or all of placenta separates before delivery,.
1% pregnancies
Visible haemorrhage in 20%
2
Q
Risk factors
A
MAJOR: IUGR Pre-eclampsia Pre-existing hypertension Smoking Previous history MINOR: Autoimmune disease Cocaine Multiple pregnancy High parity Trauma
3
Q
Clinical features
A
Painful bleeding - pain constant with exacerbations; blood dark; degree of bleeding does not indicate severity Collapse Tachycardia Hypotension Uterus tender and often contracting 'Woody' hard abdomen - foetus difficult to feel Poor urine output Foetus may be dead or distressed
4
Q
Investigations
A
CTG - foetal wellbeing US - foetal weight (if preterm); rule out placenta preavia FBC; coag screen; cross match; U+E Catherterisation and hourly urine output (Central venous pressure)
5
Q
Management - assessment and resus
A
ABCDE Admission IV fluids Steroids <34 weeks Anti-D (Rh -ve) Analgesia (opiate) Consider blood transfusion
6
Q
Management - delivery
A
Stabilise mother first
If foetal distress: urgent C-section
No foetal distress; >37w: induction with amniotomy, continuous foetal monitoring and C-section if distress
Foetus dead: coagulopathy likely; give blood products and induce labour
No foetal distress; preterm; abruption minor: conservative - close monitoring; if symptoms settle, discharged as high risk with growth scans
7
Q
Management - postpartum
A
PPH major risk
8
Q
Complications
A
Fetal death (30%) Haemorrhage => blood transfusion DIC Renal failure Above may rarely lead to maternal death
