Placental abruption Flashcards
What is the pathogenesis of placental abruption?
- rupture of spiral arterioles leads to bleeding hemorrhage in decidua basalis -> occurs in diseased vessels (like preeclampsia)
- secondary to inflammation or infection
What are the risk factors for placental abruption?
- chorioamnionitis
- PROM
- advanced maternal age
- high parity
- pre-eclampsia
- chronic hypertension
- polyhydramnios
- multiple gestation
- prior placental abruption
- trauma
What is the clinical presentation of placental abruption?
- sudden onset of abdominal pain, vaginal bleeding & uterine tenderness
- back pain
- severe bleeding could lead to shock
- fetal distress
- hypertonic uterus if it occurred during labour
When is placental abruption classified as severe?
1- maternal complications: DIC, shock, renal impairment, hysterectomy
2- fetal complications: non reassuring fetal heart tracing, fetal death
3- neonatal death
What are the maternal complications?
1- consumptive coagulopathy/DIC -> with massive bleeding -> give FFP
2- couvelaire uterus -> uterine atony
3- END organ damage -> hypovolemia & shock -> acute kidney injury
4- Sheehan’s syndrome = pituitary failure
What are the fetal complications with placental abruption?
- fetal asphyxia
- prematurity
- fetal death
How is placental abruption diagnosed?
- painful vaginal bleeding
- US -> presence of retroplacental hematoma
- MRI -> highly sensitive
How is placental abruption managed?
1- Resuscitation -> crystalloids, blood, blood products
2- expectant management
- preterm fetus
- stable
- can give tocolytic
3- Vaginal delivery
- dead fetus
- viable stable babies with normal fetal wellbeing test
- starts spontaneously or amniotomy can be done
4-emergency C section
- fetal compromise, viable fetus & vaginal delivery not imminent
- hemodynamic instability
- bleeding if DIC developed
- check platelet, Hb & clotting profile
- crossmatching of blood
