Placental Abruption

This is when the placenta prematurely detaches from the uterus.  Bleeding may or may not be shown (revealed/concealed), but there is always high risk of foetal hypoxia and intra-uterine death given that the blood loss is both maternal and foetal.  Note that if blood is shown, it may precent a while after the abruption/bleeding started (can be more than a day).

Risks

Associated with:

  • pre-eclampsia
  • past history of placental abruption in previous pregnancy
  • smoking
  • history of c-section
  • multiple pregnancy
  • thrombophilia

Clinical Features

  • Small or large volume blood loss
  • Painful
  • Uterine irritation
    • This may cause cramp like contractions- these are not actual contractions and may disrupt actual labour by preventing synchronous contraction
  • Tense, tender uterus that can be large for dates
    • ‘Couvelaire uterus’ is when blood from inside the uterus (from abrupted placenta), penetrates its wall and enters the peritoneal cavity.  This is a life threatening situation and patients usually present with shock (the uterus may appear blue/purple too).
  • Difficult to feel foetal parts
  • CTG- foetal distress/foetal death are, unfortunately, common in placental abruption.

Complications

Management

  • Admission is always necessary- manage any blood loss/shock; IV access and blood group/save/crossmatch etc
  • If there is still signs of foetal life- delivery should be induced (either vaginal or c-section) to try and save the child (this is if there is no risk to the mother- note that c-section may not be appropriate if blood loss is substantial)
    • Vaginal still birth will occur if the foetus has died
  • If bleeding is minor and CTG show no signs of foetal distress, expectant c-section should be planned (steroid use etc)
  • Anti-D antibody
  • Paediatrics should be informed if child is born as it is likely the child will require support in a neonatal unit and possibly longer-term also.
  • If the mother has lost a significant amount of blood, she may be at risk of Sheehan’s syndrome and renal failure, and she should be managed accordingly

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