Placental abruption + Placental praevia (zero to finals)

Question 1

What is placental abruption?

Answer 1

When the placenta separates from the wall of the uterus during pregnancy.

Question 2

What is a significant cause of antepartum haemorrhage?

Answer 2

Placental abruption

Question 3

What are the risk factors for placental abruption?

Answer 3

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 4

Typical presentation of placental abruption?

Answer 4

Sudden onset severe abdominal pain that is continuous

Vaginal bleeding (antepartum haemorrhage)

Shock (hypotension and tachycardia)

Abnormalities on the CTG indicating foetal distress

Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage

Question 5

What are the different classifications for vaginal bleeding?

Answer 5

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 6

What is a concealed abruption?

Answer 6

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

The severity of bleeding can be significantly underestimated with concealed haemorrhage.

Question 7

What is a revealed abruption?

Answer 7

Concealed abruption is opposed to revealed abruption, where the blood loss is observed via the vagina.

Question 8

There are certain tests for placental abruption. True/false?

Answer 8

False

Clinical diagnosis based on presentation

Question 9

What are the main initial steps for management of major or massive haemorrhage?

Answer 9

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 foetus

Close monitoring of the mother

Question 10

What is placenta praevia?

Answer 10

Placenta praevia is where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the foetus.

Question 11

When is the term “low-lying placenta” used?

Answer 11

Used when the placenta is within 20mm of the internal cervical os

Question 12

When is the term “placenta praevia” used?

Answer 12

Used only when the placenta is over the internal cervical os

Question 13

Apart from placental abruption, what is a notable cause of antepartum haemorrhage?

Answer 13

Placental praevia

Question 14

3 main causes of antepartum haemorrhage?

Answer 14

Placental praevia, placental abruption and vasa praevia

Question 15

Causes of spotting or minor bleeding in pregnancy?

Answer 15

Cervical ectropion, infection and vaginal abrasions from intercourse or procedures.

Question 16

What does placental praevia increase the risk of?

Answer 16

Antepartum haemorrhage
Emergency caesarean section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth

Question 17

2 main grades of placental praevia?

Answer 17

“Low lying placenta” - within 20mm over the internal OS.

“Placental praevia” - directly over the internal OS.

Question 18

Risk factors for developing placental praevia?

Answer 18

Previous caesarean sections

Previous placenta praevia

Older maternal age

Maternal smoking

Structural uterine abnormalities (e.g. fibroids)

Assisted reproduction (e.g. IVF)

Question 19

At what point of gestation can placental praevia be diagnosed?

Answer 19

20 weeks at anomaly scan

Question 20

What is the typical presentation for placental praevia?

Answer 20

Many women with placenta praevia are asymptomatic.

It may present with painless vaginal bleeding in pregnancy (antepartum haemorrhage).

Bleeding usually occurs later in pregnancy (around or after 36 weeks).

Question 21

If placental praevia or low lying placenta is diagnosed early at the 20 week anomaly scan, what else is done after this?

Answer 21

repeat transvaginal ultrasound scan at:

32 weeks gestation
36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)

Question 22

When may emergency caesarian section be carried out?

Answer 22

May be required with premature labour or antenatal bleeding.

Question 23

What is the main complication of placental praevia?

Answer 23

Haemorrhage before, during and after surgery

When this happens urgent management is required?.

Question 24

What is urgent management for haemorrhage in placenta praevia?

Answer 24

Emergency caesarean section
Blood transfusions
Intrauterine balloon tamponade
Uterine artery occlusion
Emergency hysterectomy

Question 25

What is a low lying placenta?

Answer 25

When placenta is within 20mm of internal OS.

Question 26

What is placental praevia?

Answer 26

When placenta lies over the internal OS