Placental abruption Flashcards
What is placentak abruption?
Placenta seperates from wall of uterus during pregnancy - The site of attachment can bleed extensively after the placenta separates
Risk factors for placental abruption
Prev PA
Pre-eclampsia
Bleeding early in pregnancy
Trauma (consider domestic violence)
Multiple pregnancy
Foetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use
Presentation of placental abruption
Sudden onset sev continious abdominal pain
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension and tachycardia)
Abnormalities on CTG indicating foetal distress
Characterisitc woody abdomen on plapation suggesting large haemorrhage
Severity of antepartum haemorrhage
- 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 concealed abruption?
Cervical os remains closed - bleeding remains inside the uterine cavity
Severity therefore underestimated
Can be mixed revealed, concealed or mixed
How to diagnose abruption
No reliable tests - clincial diagnosis
What is the severeity of the emergency determined by?
Placental separation
Extent of bleeding
Haemodynamic stability of the mother
Condition of the foetus
Initial steps with major or massive harmorrhage
Urgent involvement of senior obs, midwige and anaesthetist
2 x grey cannulas
Bloods - FBC, U+Es, LFTs and coagulation
Crossmatch - 4 units of blood
Fluid and blood resus as required
CTG monitoring of foetus
CLose monitoring of mother
When are antenatal steroids offered between and why
between 24 and 34+6 weeks
Mature foetal lungs in anticipation of preterm delivery
When are antenatal steroids offered between and why
between 24 and 34+6 weeks
Mature foetal lungs in anticipation of preterm delivery
What do rhesus D negative women require when bleeding occurs?
Anti-D prophylaxis and kleihauer test to quantify dose
Why is active managemnet of third stage recommended in placental abruption
Postpartum haemorrhage risk
