Placental abruption + Placental praevia (zero to finals) Flashcards
What is placental abruption?
When the placenta separates from the wall of the uterus during pregnancy.
What is a significant cause of antepartum haemorrhage?
Placental abruption
What are the risk factors for placental abruption?
Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use
Typical presentation of placental abruption?
Sudden onset severe abdominal pain that is continuous
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension and tachycardia)
Abnormalities on the CTG indicating foetal distress
Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage
What are the different classifications for vaginal bleeding?
Spotting: spots of blood noticed on underwear
Minor haemorrhage: less than 50ml blood loss
Major haemorrhage: 50 – 1000ml blood loss
Massive haemorrhage: more than 1000 ml blood loss, or signs of shock
What is a concealed abruption?
Where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity.
The severity of bleeding can be significantly underestimated with concealed haemorrhage.
What is a revealed abruption?
Concealed abruption is opposed to revealed abruption, where the blood loss is observed via the vagina.
There are certain tests for placental abruption. True/false?
False
Clinical diagnosis based on presentation
What are the main initial steps for management of major or massive haemorrhage?
Urgent involvement of a senior obstetrician, midwife and anaesthetist
2 x grey cannula
Bloods include FBC, UE, LFT and coagulation studies
Crossmatch 4 units of blood
Fluid and blood resuscitation as required
CTG monitoring of the foetus
Close monitoring of the mother
What is placenta praevia?
Placenta praevia is where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the foetus.
When is the term “low-lying placenta” used?
Used when the placenta is within 20mm of the internal cervical os
When is the term “placenta praevia” used?
Used only when the placenta is over the internal cervical os
Apart from placental abruption, what is a notable cause of antepartum haemorrhage?
Placental praevia
3 main causes of antepartum haemorrhage?
Placental praevia, placental abruption and vasa praevia
Causes of spotting or minor bleeding in pregnancy?
Cervical ectropion, infection and vaginal abrasions from intercourse or procedures.
What does placental praevia increase the risk of?
Antepartum haemorrhage
Emergency caesarean section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth
2 main grades of placental praevia?
“Low lying placenta” - within 20mm over the internal OS.
“Placental praevia” - directly over the internal OS.
Risk factors for developing placental praevia?
Previous caesarean sections
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities (e.g. fibroids)
Assisted reproduction (e.g. IVF)
At what point of gestation can placental praevia be diagnosed?
20 weeks at anomaly scan
What is the typical presentation for placental praevia?
Many women with placenta praevia are asymptomatic.
It may present with painless vaginal bleeding in pregnancy (antepartum haemorrhage).
Bleeding usually occurs later in pregnancy (around or after 36 weeks).
If placental praevia or low lying placenta is diagnosed early at the 20 week anomaly scan, what else is done after this?
repeat transvaginal ultrasound scan at:
32 weeks gestation
36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)
When may emergency caesarian section be carried out?
May be required with premature labour or antenatal bleeding.
What is the main complication of placental praevia?
Haemorrhage before, during and after surgery
When this happens urgent management is required?.
What is urgent management for haemorrhage in placenta praevia?
Emergency caesarean section
Blood transfusions
Intrauterine balloon tamponade
Uterine artery occlusion
Emergency hysterectomy
What is a low lying placenta?
When placenta is within 20mm of internal OS.
What is placental praevia?
When placenta lies over the internal OS
