Placental Abruption Flashcards
1
Q
Define Placental Abruption.
A
Separation of the placenta from the uterine wall before delivery over >24 weeks
- If <24w = miscarriage
2
Q
What are the risk factors for placental abruption?
A
- HTN
- Previous APH
- PPROM
- Abdominal trauma
- Smoking
- Cocaine
- Polyhydramnios
70% occur in low-risk pregnancies
3
Q
What are the signs and symptoms of placental abruption?
A
-
Constant abdominal pain ± PV bleeding
- If revealed - 80%, 20% are concealed
- Sustained contractions
- On examination:
- General – shock Abdomen – hypertonic “woody” tender uterus
- Speculum – assess bleeding
- Vaginal exam (NOT in praevia) – cervical dilatation
4
Q
What are the appropriate investigations for suspected placental abruption?
A
- Bloods – FBC, clotting, U&E, crossmatch
- USS – exclude praevia – abruption unlikely to be present unless very large
5
Q
What is the management of placental abruption?
A
- Mild
- Preterm and stable = Conservative management with close monitoring with IOL at term
- Admit for at least 48 hours or until bleeding stops
- Anti-D Ig followed by Kleihauer test
- Preterm and stable = Conservative management with close monitoring with IOL at term
- Severe
- ABC assessment, 2 wide bore cannulae, fluids, bloods, correct coagulopathies
- Emergency CS
- Bloods - FBC, G&S, crossmatch, Kleihauer test
- Steroids to mature babies lungs (<35 weeks)
- CTG (if >27w) → consider IOL if foetal compromise
6
Q
What are the complications of placental abruption?
A
- Maternal
- Haemorrhage - APH, PPH
- DIC
- Renal failure
- “Couvelaire uterus” - extravasation of blood into myometrium and beneath the peritoneum → very hard uterus
- Foetal
- Birth asphyxia
- Death
- Prognosis
- Maternal = 0.5% mortality in severe abruption
- Foetal – 3.3% mortality in severe abruption
7
Q
What is a Couvelaire uterus?
What is the sign of placental abruption?
A
Extravasation of blood into myometrium and beneath the peritoneum
Very hard uterus
