Placental abruption

Question 1

Define placental abruption

Answer 1

Premature separation of the placenta from the uterine wall.

Question 2

What is the uterus like in placental abruption?

Answer 2

Woody, tense uterus

Question 3

Give 2 potential consequences of placental abruption.

Answer 3

Foetal distress

Maternal shock

Question 4

Give 5 risk factors for placental abruption.

Answer 4

Previous placental abruption
Domestic violence
Smoking
Trauma i.e RTA
Multiple pregnancy - uterine overdistension
Polyhydramnios
Increasing BMI
Placenta praevi
Hypertension/Pre-eclampsia

Question 5

What are some SSx of placental abruption?

Answer 5

Sudden onset abdominal pain
Fetal compromise
PV bleeding (may be little if concealed bleed)
Uterine contractions

Signs:

• Tender uterus with wooden feel
• Cannot auscultate fetal heart
• Fetal parts difficult to feel

Question 6

Definitive Tx for placental abruption?

Answer 6

ABCDE for resuscitation (if required)

Fetus alive and < 36 weeks:
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks:
fetal distress: immediate caesarean
no fetal distress: deliver vaginally

Fetus dead:
induce vaginal delivery

Question 7

Complications of placental abruption?

Answer 7

DIC
Anuria (due to poor perfusion of kidneys)
Post-partum haemorrhage
Antepartum haemorrhage

Question 8

A 36-year-old female who is 30 weeks pregnant presents to the emergency department with severe lower abdominal pain. She is tachycardic but is otherwise stable. On examination, her uterus is tender and hard, but fetal lie is normal. Cardiotocography shows no signs of fetal distress.

Here are her vital signs:
Heart rate = 110bpm
Respiratory rate = 20/minute
Blood pressure = 118/84mmHg
Oxygen saturation = 95% on air
Temperature = 37.5ºC

What is the next best step in Mx?

A. Admit her and administer steroids
B. Admit her and give tocolytics
C. Discharge with safety netting
D. Emergency C-section
E. Call 2222 and initiate major haemorrhage protocol

Answer 8

A. Admit and administer steroids

Admit all patients with placental abruption. As she is haemodynamically stable, there is no need for C-section/major haemorrhage protocol.

Tocolytic not indicated in placental abruption and it’s impt to give steroids as the baby is premature