Placental abruption

Question 1

What is placental abruption?

Answer 1

The placental lining has separated from the uterus of the mother prior to delivery. The placental attachment is disrupted by haemorrhage as blood dissects under the placenta, possibly extending into the amniotic sac or the uterine muscle.

Question 2

What proportion of pregnancies in the UK are affected by placental abruption?

Answer 2

1%

Question 3

What are the risk factors for developing placental abruption?

Answer 3

Previous abruption

Advanced maternal age

Multiparity

Maternal hypertension or pre-eclampsia

Abdominal trauma (eg following RTA)

Cigarette smoking

Cocaine use

Lower SEC

External cephalic version (manoeuvre used when baby is lying in wrong position)

Question 4

What are the clinical features of placental abruption?

Answer 4

Sudden onset abdominal pain
Prolonged contractions
Tenderness of abdomen
Vaginal bleeding (however, not always present as haemorrhage can be internal)
Haemorrhagic shock
Symptoms of pre-eclampsia - headache, blurred vision, nausea, epigastric pain

Question 5

On examination of a patient with placental abruption, what would you expect to find?

Answer 5

Tender uterus

Tonic contraction felt - makes uterus feel hard

Difficult to palpate fetal parts

BP and proteinuria should be checked due to association between pre-eclampsia and abruption.

Question 6

What pattern on the CTG would indicate feto-maternal haemorrhage?

Answer 6

Sinusoidal pattern

Question 7

How would you manage a patient with placental abruption?

Answer 7

ABCDE approach

Immediate caesarian section if there is maternal or fetal compromise

Steroids to improve fetal lung maturity

Question 8

What are the complications of placental abruption?

Answer 8

Severe haemorrhage - DIC and renal failure

Postpartum haemorrhage which can lead to Sheehan’s syndrome (pituitary necrosis secondary to hypovolaemic shock)

Question 9

What condition is associated with placental abruption?

Answer 9

Pre eclampsia