Placental Abruption

Question 1

Define placental abruption

Answer 1

Part or all of the placenta separates from the wall of the uterus prematurely

Important cause of antepartum haemorrhage (vaginal bleeding >24w-delivery)

Question 2

Outline the pathophysiology of placental abruption

Answer 2

Rupture of maternal vessels within basal layer of endometrium = blood accum = splits placenta from basal layer = rapid fetal compromise

Revealed = vaginal bleeding

Concealed = bleeding remains in uterus, form clot

Question 3

List the risk factors for placental abruption

Answer 3

• Placental abruption in previous pregnancy (most predictive factor)
• Pre-eclampsia and other hypertensive disorders
• Abnormal lie of the baby e.g. transverse
• Polyhydramnios
• Abdominal trauma
• Smoking or drug use e.g. cocaine
• Bleeding in 1st trimester, particularly if a haematoma is seen inside the uterus on a first trimester scan
• Underlying thrombophilias
• Multiple pregnancy

Question 4

How can placental abruption present?

Answer 4

PAINFULL vaginal bleeding

Tense uterus

Painful uterus on palpation

Question 5

Give a DDx for antenatal haemorrhage

Answer 5

Placental abruption

Placenta praevia

Marginal placental bleed (partial abruption)

Vasa pravia = rupture of the umbilical cord vessels

Uterine rupture

Benign or malignant lesions

Infections = candida, bacterial vaginosis and chlamydia

Question 6

How should antenatal bleeding be investigated?

Answer 6

Bloods = FBC, clotting, G+S, X match, U+Es, LFTs
- Kleihauer test (foetal cells in maternal blood)

Cardiotocograph (CTG)

US

Question 7

How should placental abruption be managed?

Answer 7

Emergency delivery (CS) = if fetal compromise

Induction of labour = for haemorrhage at term without fetal/maternal compromise

Anti-D within 72h if Rh-ve