Placental Abruption

Question 1

Placental Abruption Definition

Answer 1

Premature separation of placenta, leading to blood collecting between placenta and uterus

• One of two most important causes of antepartum haemorrhage (other is praevia)
• Two main forms
• Concealed (20%)- haemorrhage confined to uterine cavity, more severe, blood loss easily underestimated
• Revealed (80%)- blood drains through cervix, usually with complete detachment and fewer problems
• Marginal haemorrhage

Question 2

Placental Abruption RFs

Answer 2

• PHx
• Multiple pregnancy
• Trauma
• Previous threatened miscarriage
• Pre-eclampsia
• Hypertension
• Multiparity
• Previous C-section, smoking…
• Sudden unexpected emergency, usually occurs in pregnancies with no risk factors, so cannot be predicted in most cases

Question 3

Placental Abruption Presentation

Answer 3

-Vaginal bleeding, abdominal pain, uterine contractions, shock, foetal distess

Question 4

Placental Abruption Diagnosis

Answer 4

• Clinical diagnosis
• No available reliable tests
• Tense, tender, woody, uterus suggests significant abruption
• Exclude pre-eclampsia and HELLP (FBC, U&Es, LFTs)
• Ultrasound is not reliable and cannot be used to exclude

Question 5

Placental Abruption Management

Answer 5

• Stabilise and set up monitoring
• Vaginal delivery if live foetus >34 weeks (induce)
• Conservative management if foetus stable and <34 weeks
• C-section if foetus unstable