Placental abruption - GM

Question 1

placental abruption is a cause of

Answer 1

antepartum haemorrhage (bleeding >24 weeks gestation)

Question 2

placental abruption is when

Answer 2

there is premature seperation of a normall sited placenta from the uterine wall, resulting in maternal haemorrhage of the intervening space

Question 3

aetiology of placental abruption

Answer 3

cause not known
more likley to occur in the third trimester, particularly last few weeks before birth

Question 4

two types of placental abruption

Answer 4

concealed - bleeding remains in the uterus and is not visible
revealed - visible vaginal bleeding

Question 5

risk factors for placental abruption

Answer 5

previous history of placenta abruption
pre eclampsia
fetal complications: IUGR, non-vertex presentations, polyhydramnios
advanced maternal age
multiparity
low BMI
IVF
intrauterine infection
premature rupture of membranes
abdominal trauma
smoking and drug use

Question 6

typical Hx of placental abruption

Answer 6

sudden constant pain with or without dark red vaginal bleeding (>24 weeks)

Question 7

things to ask about on Hx taking

Answer 7

rupture of membranes: if yes, consider vasa praevia
provoking factors (eg. post-coital)
fetal movements
risk factors (eg. smoking/drug use)
obstetric history: previous pregnancies, delivery mode, gestation and complications
past medical history
IVF Hx

Question 8

clinical examination

Answer 8

digital vaginal examination should not be performed as this may trigger heavy bleeding in unconfirmed placenta praevia
speculum examination to look for cervical dilatation, ruptured membranes and investigate for infection
fetus should have CTG if 26 weeks or above

Question 9

typical clinical findings for placental abruption

Answer 9

abdominal tenderness: constant pain is consistant with abruption
uterus feels ‘woody’ or ‘tense’
signs of shock

Question 10

ddx of placental abruption

Answer 10

placenta praevia: usually painless, bright red bleeding
vasa praevia: where fetal blood vessels run near the internal cervical os
uterine rupture: usually occurs in labour with a Hx of previous cesarean section
early labour may present with a small amount of bleeding and intermittant abdominal pain
malignant lesions (eg. carcinoma)
benign lesions (eg. cervical ectropian)
infections (eg. chlamydia)

Question 11

how to tell if it is actually vasa praevia

Answer 11

usually presents with the triad of vaginal bleeding, rupture of membranes and fetal deterioration

Question 12

when to perform a CTG

Answer 12

should be performed in women above 26 weeks gestation to assess fetal wellbeing
abrutpion can result in fetal hypoxia
under 26 weeks a handheld USS doppler should be performed to assess fetal heartbeat

Question 13

lab investigations

Answer 13

FBCs, U&Es, LFTs, baseline blood tests
group and hold: if there is large volumes of blood loss patient may require transfusion
coags: important in the context of bleeding
kleihauer test: required if the woman is rhesus negative