Placental abruption

Question 1

What is placental abruption?

Answer 1

Partial or complete separation of the placenta from the uterus prior to delivery. Subsequent hemorrhage occurs from both maternal and fetal vessels

Occurs most often in 3rd trimester

Question 2

What are the risk factors of placental abruption?

Answer 2

Hypertension/pre-eclampsia 
Abdominal trauma (up to 10% of cases)
Sudden decrease in intrauterine pressure (i.e. multiple births, premature uterine membrane rupture) 
Previous abruption
Alcohol, smoking, cocaine use 
Maternal age: < 20 years and > 35 years

Question 3

What are the clinical features of placental abruption?

Answer 3

Continuous, dark, vaginal bleeding (revealed abruptio placentae)
20% of cases, the hemorrhage is mainly retroplacental; vaginal bleeding does not occur (concealed abruptio placentae)
Abdominal pain or back pain , uterine tenderness
Foetal distress (reduced movement and heart rate)

Question 4

How is placental abruption diagnosed?

Answer 4

Ultrasound (transabdominal, transvaginal), low sensitivity

Fetal heart rate monitoring

Question 5

What is the treatment for placental abruption?

Answer 5

Hemodynamic control
(Normal fetal findings and a hemodynamically stable mother) Watch and wait, induced labour if needed
(Acute symptoms) Emergency caesarian

Question 6

What are the complications of placental abruption?

Answer 6

Intrauterine fetal death
Maternal Disseminated intravascular coagulation (DIC) and hypovolemic shock
Uterine rupture