Placental abruption

Question 1

Defintion

Answer 1

• Placenta seperates from the wall of uterus during pregnancy.
• Site of attachment can bleed after placenta separates

Question 2

Risk factors

Answer 2

• Previous placental abruption
• Pre-eclampsia
• Bleeding early in pregnancy
• Trauma (consider domestic violence)
• Multiple pregnancy
• Fetal growth restriction
• Multigravida
• Increased maternal age
• Smoking
• Cocaine or amphetamine use

Question 3

Presentation

Answer 3

• vaginal bleeding
• sudden onset continuous severe abdo pain
• shock
• fetal distress
• woody abdomen

Question 4

How to assess severity

Answer 4

• 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

Question 5

What is a concealed abruption?

Answer 5

Concealed abruption is when cerivcal os is closed so bleeding is within the uterine cavity
Means that severity of bleeding is underestimated

Question 6

Diagnosis

Answer 6

Clinical diagnosis
Could do USS to exclude placenta praevia

Question 7

Treatment

Answer 7

• Antenatal steroids
  OBSTETRIC EMERGANCY
• Urgent involvement of a senior obstetrician, midwife and anaesthetist
• 2 x grey cannula
• Bloods include FBC, UE, LFT and coagulation studies
• Crossmatch 4 units of blood
• Fluid and blood resuscitation as required
• CTG monitoring of the fetus
• Close monitoring of the mother
• Rhesus-D negativewomen requireanti-D prophylaxis when bleeding occurs.
• Emergency C section