Placental abruption

Question 1

What is placental abruption?

Answer 1

Refers to when the placenta separates from the wall of the uterus during pregnancy and the site of attachment can bleed extensively causing antepartum haemorrhage.

Question 2

What are the risk factors for placental abruption?

Answer 2

Previous placental abruption, pre-eclampsia, bleeding in early pregnancy, trauma (domestic violence), multiple pregnancy & multigravida, smoking & amphetamine use.

Question 3

What is the presentation of placental abruption?

Answer 3

• Sudden onset severe abdominal pain that is continuous
• vaginal bleeding (antepartum haemorrhage)
• shock (hypotension & tachycardia) out of keeping with visible loss
• tender and tense uterus,
• abnormalities on CTG including fetal distress (fetal heart absent/distressed)
• characteristic ‘woody’ abdomen on palpation suggesting a large haemorrhage

Question 4

What are the severity levels of antepartum haemorrhage?

Answer 4

• Spotting
• minor haemorrhage (less than 50ml of blood loss)
• major haemorrhage (50-1000ml blood loss)
• massive haemorrhage (more than 1000ml blood loss or signs of shock).

Question 5

What is concealed abruption?

Answer 5

Where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity.

Question 6

What is revealed abruption?

Answer 6

Where the blood loss is observed via the vagina.

Question 7

How is placental abruption diagnosed?

Answer 7

A clinical diagnosis based on presentation.

Question 8

What initial steps are taken in this obstetric emergency?

Answer 8

• Urgent involvement of a senior obstetrician
• 2x grey large borne cannula, bloods (FBC, U&Es, LFTs, coagulation)
• crossmatch 4 units of blood, fluid & blood resuscitation as required
• CTG monitoring of fetus, close monitoring of mother
• anti-D prophylaxis for rhesus D negative women when bleeding occurs

Question 9

When may an emergency c-section be needed?

Answer 9

If the mother is unstable or there is fetal distress.

Question 10

What do you offer between 24 and 34 + 6 weeks?

Answer 10

Antenatal steroids to mature fetus lungs in anticipation of preterm delivery.

Question 11

What is there an increased risk of after delivery in women with placental abruption?

Answer 11

Postpartum haemorrhage after delivery in women with placental abruption. Active management of third stage is recommended.