Placental Abruption

Question 1

What is placental abruption?

Answer 1

Placental abruption refers to when the placenta separates from the wall of the uterus during pregnancy.

This can lead to extensive bleeding and is a significant cause of antepartum haemorrhage.

Question 2

What are some risk factors for placental abruption?

Answer 2

• previous placental abruption
• pre-eclampsia
• bleeding early in pregnancy
• trauma (i.e. domestic violence)
• multiple pregnancy
• foetal growth restriction
• multigravida
• increased maternal age
• smoking
• cocaine or amphetamine use

These factors can increase the likelihood of experiencing placental abruption.

Question 3

What are the typical clinical features of placental abruption?

Answer 3

• sudden onset severe abdominal pain that is continuous
• vaginal bleeding (antepartum haemorrhage)
• shock (hypotension, tachycardia)
• abnormal CTG findings
• characteristic ‘woody’ abdomen on palpation

These symptoms can help in identifying a potential case of placental abruption.

Question 4

What are the severity guidelines for placental abruption according to RCOG 2011?

Answer 4

• spotting - spots of blood on underwear
• minor haemorrhage - <50ml blood loss
• major haemorrhage - 50 to 1000ml blood loss
• massive haemorrhage - >1000ml blood loss, or signs of shock

These guidelines help categorize the severity of the condition.

Question 5

What is concealed abruption?

Answer 5

Concealed abruption occurs when cervical os remains closed, and any bleeding that occurs remains within the uterine cavity.

The severity of bleeding can be significantly underestimated in these cases.

Question 6

How is placental abruption diagnosed?

Answer 6

Placental abruption is a clinical diagnosis based on presentation, as there are no reliable tests for diagnosing it.

Clinical signs and symptoms are crucial for the diagnosis.

Question 7

What is the initial management for placental abruption?

Answer 7

• urgent senior involvement
• 2x grey cannula
• bloods and coagulation studies
• crossmatch 4 units of blood
• fluid and blood resuscitation as required
• CTG foetal monitoring
• close maternal monitoring

Immediate action is required due to the potential severity of the situation.

Question 8

What other treatments are offered for placental abruption?

Answer 8

• antenatal steroids offered between 24 and 34+6 weeks gestation to mature lungs in anticipation of preterm delivery
• anti-D prophylaxis for rhesus-D negative women (Kleihauer test used to determine dose required)
• emergency c-section

These treatments help manage risks associated with placental abruption.