Placental abruption

Question 1

What is placental aburption

Answer 1

Seperation of placenta from uterine wall BEFORE delivery
If <24w. If over 24w misscarriage
haemorhgae can be concealred or revealed (80)-1-2% of preg
Idiopathic

RF-
HTN, Polyhydramnios
previous APH, PPROM, Adbo trauma, somking/cocaine,

Question 2

Sx and Ix of placental aburption

Answer 2

Sx- constant abdo pain
PV bleeding (if revealed)- <24w APH, >24w misscarriage
sustained contraction
exam-
Shock
ABdo= hypertonic "woody" tender uterus
Speculum to assess bleed
vaginal-dilation 
(reminder- abprution pain+bleed, Praevia- bleed, No pain)

if unsure if praevia-dont do bimanual

Question 3

Mx of placental aburption

Answer 3

Mild- of preterm and stable- conservative mx and monitoring
IOL at term
admit for 48h or until bleeding stop
Anti D Ig followed by Kleihaer

Severe- ABC, Emergency CS, blood transfuse
CTG if>27w, IOL, TVUSS (for praveia

Question 4

Complications of placental aburption

Answer 4

maternal - heamorrhage, DIC, renal failure
Foetal- birth asphyxia, death
prog
maternal 0.5% mortality in severe
baby 3.5 in severe