Overview

• When the placenta seperates from the wall of the uterus during pregnancy resulting in maternal haemorrhage into the intervening space → significant cause of antepartum haemorrhage.

  • Haemorrhage may be concealed (20%) or revealed (80%).
  • Concealed Abruption → cervical os remains closed, therefore any bleeding that occurs remains within the uterine cavity. Vaginal bleeding is therefore disproportionate to the uterine bleeding.

• Risk Factors → previous placental abruption, pre-eclampsia (HTN), bleeding early in pregnancy, trauma (consider domestic violence), multiple pregnancy, foetal growth restriction, multigravida, increased maternal age, smoking, cocaine use, polyhydramnios.

  <aside> 💡 ABRUPTION:

  A for Abruption previously;

  B for Blood pressure (i.e. hypertension or pre-eclampsia);

  R for Ruptured membranes, either premature or prolonged;

  U for Uterine injury (i.e. trauma to the abdomen);

  P for Polyhydramnios;

  T for Twins or multiple gestation;

  I for Infection in the uterus, especially chorioamnionitis;

  O for Older age (i.e. aged over 35 years old);

  N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

  </aside>

Making Diagnosis

Clinical Features

• Sudden onset constant severe abdominal pain.
• Vaginal bleeding (MAY BE CONCEALED).
• Shock → hypotension + tachycardia.
• Abnormalities on CTG indicating fetal distress.
• ‘Woody’ hard uterus on palpation → indicates large haemorrhage.

Investigations

• Bloods → FBC, clotting, U&E, crossmatch.
• USS → exclude placenta praevia (PAINLESS).
  • Praevia = bleeding + no pain. Abruption = bleeding + pain.
• CTG → DETERMINE IF ANY FOETAL DISTRESS.

Management Plan

• ABCDE Approach ⇒
  • 2x IV access.
  • Bloods → FBC, rhesus status, cross-match, clotting screen.
  • Continuous fetal monitoring on CTG.
  • Kleihauer test and anti-D if needed.