Placental abruption

• Overview:

  • Placental abruption is the complete or partial detachment of the placenta before delivery
  • Partial abruption is more common than complete
  • Accounts for around a quarter of all cases of APH
  • Large cause of perinatal mortality
• The cause of placental abruption is often unknown

  It may occur due to trauma or injury to the abdomen
• Risk factors:

  • History of previous abruptions
  • Hypertension
  • Pre-eclampsia
  • Smoking
  • Cocaine during pregnancy
  • Anti-phospholipid syndrome and thrombophilia
  • Trauma
• Symptoms:

  • Abdominal pain - posterior placental abruptions may present with back pain
  • Vaginal bleeding
  • Uterine contractions
  • Dizziness and/or loss of consciousness
• The amount of blood loss often correlates poorly with the degree of abruption.

  Abruption may be ‘revealed’ where blood tracks between membranes and out of the vagina. It can however be ‘concealed’ where the blood accumulates with no obvious external bleeding.
• Exam findings:

  • uterus - tender, 'woody hard'
  • Foetal heart - absent or distressed
• Investigations:

  • FBC, U&Es, LFTs
  • Clotting
  • Kleihauer test
  • Group and save + crossmatch
  • USS
  • CTG
• Management if foetus alive:

  • No signs of distress - observe closely or induce and deliver vaginally if over 36 weeks
  • Signs of distress - immediate caesarean section
• If the foetus is dead - induce vaginal delivery unless mother haemodynamically compromised - immediate caesarean section
• Complications for the mother:

  • Major haemorrhage - activate major haemorrhage protocol
  • Shock - can result in Sheehan syndrome
  • Compression of the uterine muscles prevents good contractions during labour
  • Release of thromboplastin for placental haematoma - can lead to DIC
  • Post-partum haemorrhage
• Complications for the foetus:

  • Placental insufficiency - hypoxia and intrauterine growth restriction
  • Premature birth
  • Still birth