Placental Abruption
(abruptio placentae, accidental haemorrhage)
- premature separation of normally situated placenta
- revealed, concealed or mixed
- 0.4-3.5% pregnancies
Aetiology
- spasm of uterine vessels followed by flooding into choriodecidual space
- folic acid deficiency
- trauma from external cephalic version / direct blow
- sudden release of polyhydramnios
- traction of short cord
Risk factors
- multiparity
- anaemia
- previous abruption
- pre-eclampsia
- hypertension
- cardiovascular disease
- rheumatoid disease
- cocaine
Symptoms and signs
- vaginal bleeding
- abdominal pain - greatest in concealed bleed
- tense and tender uterus (Couvelaire uterus)
- difficult to detect foetal heart or feel uterine contractions
- evidence of hypovolaemia
- foetal distress
- dead foetus
Differential
Complications
Management
- Minor degrees or uncertainty
- bed rest
- observation
- clotting screen & FBC
- Kleihauer test (indicating foetal cells in maternal circulation)
- USS to exclude placenta praevia
- Established abruption
- Rapid assessment of maternal and foetal state
- FBC, cross-match and clotting
- analgesia
- blood tranfusion - CVP monitoring
- delivery
- vaginal if foetus dead
- Caesarean if live foetus
- large doses ergometrine
as likely to be atonic uterus
Expectant management
- Hospital admission and bed rest
- General assessment
- Localise placenta
- Speculum examination NOT vaginal
- Mobilise when bleeding has stopped
- anti-D immunoglobulin where necessary
- Patient may go home if placenta praevia excluded and bleeding stopped
- Continued supervision to exclude IUGR
- Examination at 38 weeks in theatre
- Careful examination of placenta and membranes after delivery
- if bleeding does not stop - deliver!
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