Placental abruption Flashcards
What is placental abruption?
When part (or all) of the placenta separates before delivery of the foetus
What can happen when the placenta separates?
Considerable bleeding may occur behind it
What can happen to the blood from a placental abruption?
- Further placental abruption and acute foetal distress may occur
- Blood can track down between the membranes and the myometrium to be revealed as APH
- May enter the liquor
- May enter the myometrium and visible haemorrhage is absent
What is a concealed abruption?
When the blood from the separation enters the myometrium and there is no PV bleeding.
Shock in placental praevia and abruption?
Abruption = Inconsistent with external loss Praevia = Consistent with external loss
Pain in placental praevia and abruption?
Abruption = Common, often severe, Constant with exacerbations Praevia = No. Contractions occassionally
Bleeding in placental praevia and abruption?
Abruption = May be absent. Often dark Praevia = Red and often profuse. Often smaller APHs
Tenderness in placental praevia and abruption?
Abruption = Usual, often severe. Uterus may be hard Praevia = Rare
Foetal lie in placental praevia and abruption?
Abruption = Lie normal, often engaged. May be dead or distressed Praevia = Lie often abnormal / head high. Heart rate usually normal
USS in placental praevia and abruption?
Abruption = often normal, placenta not low Praevia = Placenta low
Complications of placental abruption?
- Foetal death (30%)
2. Haemorrhage often necessitates blood transfusion; this, DIC and renal failure rarely lead to maternal death
How is the uterus described in placental abruption?
As ‘woody’ hard
RFx for placental abruption?
- IUGR
- Pre-eclampsia
- Autoimmune disease
- Maternal smoking
- Cocaine usage
- Hx of placental abruption
- High maternal parity
- Occasionally trauma or sudden reduction in uterine volume (e.g. rupture of membranes)
Hx in placental abruption?
Painful bleeding
Pain = blood behind placenta and in myometrium, usually constant with exacerbations
Blood = often dark
Amount of blood doesn’t reflect severity of abruption as not all blood will leave via vagina
Examination in placental abruption?
- Tachycardia = profound blood loss (may be out of proportion to vaginal loss due to concealed loss)
- Hypotension = massive loss
- Uterus tender and often contracting; labour often ensues
- Severe cases = woody hard
- Foetus hard to feel
- Foetal heart tones are often abnormal or even absent
How is diagnosis of placental abruption made?
Usually on clinical grounds
How is foetal wellbeing established in placental abruption?
- CTG
- Tocography to monitor uterine activity
- USS to estimate foetal weight and exclude placenta praevia
How is maternal wellbeing established in placental abruption?
- FBC
- Coagulation screen
- Blood cross-match
- Catheterisation with hourly urine output
Mx of placental abruption?
- Admit
- Resuscitation if required
- IV fluid given
- Steroids given if gestation <34 weeks
- Opiate analgesia
- Anti-D to Rhesus negative women
What does delivery depend on?
Foetal state and gestation
What is done if there is foetal distress?
Urgent delivery by c-section
What is done if there is no foetal distress, but gestation is >37 weeks?
Induction of labour with amniotomy. Foetal heart closely monitored. Maternal condition closely observed and c-section if foetal distress ensues
What is done if the foetus is dead?
Coagulopathy is also likely. Blood products are given and labour is induced
When is conservative Mx done?
No foetal distress, preterm pregnancy and minor degree of abruption
Conservative Mx?
- Steroids given if <34 weeks
- Monitor pt closely on antenatal ward
- If all Sx settle, can be discharged
- However, pregnancy is now ‘high risk’; USS for foetal growth performed
