Placental Abruption

Question 1

What is placental abruption?

Answer 1

It is when the placenta separates from the decider in a normally implanted placenta

Question 2

What are the risk factor for an abruption?

Answer 2

AMA
Smoking
Illicit drug use
Hypertensive disease 
Trauma 
African American Race 
PPROM 
History of placental abruption

Question 3

What would make you suspect an abruption?

Answer 3

• Non reassuring fetal heart tone in the setting of tachyphylaxis
• Maternal abdominal pain constant
• Vaginal bleeding
• Maternal tachycardia and coagulopathy

Question 4

If an abruption is seen on ultrasound, describe the ultrasound characteristics.

Answer 4

• 50% of abruption produce no findings on ultrasound.
• Hyperechoic or isoechoic collections relative to placenta echogenicity —> turns to hypoechoic sonolucent by 2 weeks after event
• Jello sign (intrauterine clot that jiggles)
• Retroplacental hematoma

Question 5

How accurate is ultrasound in identifying an abruption?

Answer 5

50% can be seen on ultrasound.

Sensitivity - 24 %
Specificity - 96%
PPV - 88%
NPV - 53%

Question 6

Does a normal ultrasound exclude the possibility of an abruption?

Answer 6

No.

Question 7

What is a concealed abruption?

Answer 7

Preplacental abruption can lead to concealed abruption. There is no communication with cervix.

Question 8

What are the maternal risks if abruption occurs?

Answer 8

• Cesarean section
• Coagulopathy
• Hemorrhage
• Need for hysterectomy
• Renal failure

Question 9

What are the fetal risks if an abruption occurs?

Answer 9

• Preterm delivery (IVH, periventricular leukomalacia, cerebral palsy)
• PPROM
• Fetal growth restriction if chronic
• Stillbirth

Question 10

What lab tests will you order if you suspect an abruption? what does each test tell you?

Answer 10

• PT/INR - consumption of extrinsic factor
• PTT - consumption of intrinsic factor
• Fibrinogen - consumption due to formation of fibrin clots
• CBC - low platelet indicates consumption

Question 11

How do you evaluate a patient if you suspect abruption?

Answer 11

• Assess maternal hemodynamic status
• Speculum examination
• Assess vitals
• Assess labs
• Assess fetal ultrasound
• Fetalexternal monitoring

Question 12

How do you manage a patient if an abruption is diagnosed?

Answer 12

• If hemodynamically stable and no further bleeding with stable fetal surveillance; delivery at 37 weeks is acceptable with fetal growth assessment.
• If multiple bleeds then maintain in house. If more than 2 and/or hemodynamically unstable then deliver after 34 weeks