[41] Placental Abruption Flashcards

1
Q

What is placental abruption?

A

Where all or part of the placenta separates from the wall of the uterus prematurely

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2
Q

Why is placental abruption clinically important?

A

Because it is an important cause of antepartum haemorrhage

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3
Q

What causes placental abruption?

A

Thought to occur following a rupture of the maternal vessels within the basal layer of the endometrium

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4
Q

What is the result of the rupture of maternal vessels within the basal layer of the endometrium?

A

It causes blood to accumulate and splits the placental attachment from the basal layer

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5
Q

What is the result of the placental detachment from the basal layer?

A

It means the detached portion of the placenta is unable to function, leading to rapid fatal compromise

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6
Q

What are the 2 main types of placental abruption?

A
  • Revealed

- Concealed

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7
Q

What is revealed placental abruption?

A

When bleeding tracks down from the site of placental separation and drains through the cervix, resulting in vaginal bleeding

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8
Q

What is concealed placental abruption?

A

When the bleeding remains in the uterus, and typically forms a clot retroplacentally

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9
Q

What problem can concealed placental abruption cause?

A

The bleeding is not visible, but can be severe enough to cause systemic shock

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10
Q

What are the risk factors for placental abruption?

A
  • Placental abruption in previous pregnancy
  • Pre-eclampsia and other hypertensive disorders
  • Abnormal lie of the baby, e.g. transverse
  • Polyhydramnios
  • Abdominal trauma
  • Smoking or drug use, e.g. cocaine
  • Bleeding in the first trimester, particularly if haematoma seen inside the uterus on the first trimester scan
  • Underlying thrombophilia
  • Multiple pregnancy
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11
Q

How does placental abruption typically present?

A

With painful vaginal bleeding (may not be visible in concealed)

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12
Q

What may be found on examination in placental abruption?

A

Uterus may be woody (tense all the time) and painful on palpation

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13
Q

What are the differential diagnoses for placental abruption?

A
  • Placenta praevia
  • Marginal placental bleeding
  • Vasa praevia
  • Uterine rupture
  • Local genital causes
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14
Q

What is marginal placental bleeding?

A

Small, partial abruption of the placenta that is large enough to cause revealed bleeding, but not large enough to cause maternal or fetal compromise

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15
Q

What local genital causes are differentials for placental abruption?

A
  • Benign/malignant lesions

- Infections

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16
Q

What should be done regarding investigations if major bleeding is suspected?

A

Perform investigations and resuscitate simultaneously

17
Q

What investigations should be done in suspected placental abruption?

A
  • Bloods
  • Assessment of fetal wellbeing
  • Imaging
18
Q

What bloods should be done in suspected placental abruption?

A
  • FBC
  • Clotting profile
  • Kleihauer test
  • G&S
  • Cross match
  • U&Es and LFTs
19
Q

When should a Kleihauer test be done in suspected placental abruption?

A

If the women is rhesus negative

20
Q

How should fetal well-being be assessed in suspected placental abruption if the mother is above 26 weeks?

A

CTG

21
Q

When should imaging be done in suspected placental abruption?

A

When the patient is stable

22
Q

What may be seen on ultrasound in placental abruption?

A

Retroplacental haematoma

23
Q

What is the value of ultrasound in placental abruption?

A

Has a good positive predictive value

24
Q

What is the limitation of ultrasound in placental abruption?

A

Poor negative predictive value, and should not be used to exclude abruption

25
Q

What should be done in any women presenting with significant antepartum haemorrhage?

A

They should be resuscitated with an A-E approach

26
Q

What should maternal resuscitation not be delayed for?

A

To determine fetal viability

27
Q

What is the ongoing management of placental abruption dependant on?

A

The health of the fetus

28
Q

When is an emergency delivery indicated in placental abruption?

A

When there is maternal and/or fetal compromise

29
Q

How is emergency delivery performed in placental abruption?

A

Usually C-section, unless spontaneous delivery is imminent or operative vaginal birth is achievable

30
Q

Is C-section indicated in placental abruption if there is in-utero fetal death?

A

May be indicated if there is maternal compromise

31
Q

How should placental abruption be managed when there is haemorrhage at term without maternal or fetal compromise?

A

Induction of labour

32
Q

Why should induction of labour be performed when there is haemorrhage caused by placental abruption at term without compromise?

A

To avoid further bleeding

33
Q

When might conservative management for placental abruption be used?

A

For some partial or marginal abruption not associated with maternal or fetal compromise

34
Q

What does the decision regarding if conservative management for placental abruption is suitable depend on?

A

Gestation and amount of bleeding

35
Q

What should be done if the women is rhesus D negative and presents with placental abruption?

A

Anti-D should be given within 72 hours of the onset of bleeding