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
Notes on Medicine/Surgery 