Placental abruption is a cause of antepartum haemorrhage (defined as bleeding > 24 weeks gestation) and defined as premature separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space. Show Placental abruption occurs in 0.3% to 1% of births. You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. AetiologyThe cause of placental abruption is not known. Abruption is more likely to occur in the last trimester, particularly during the last few weeks prior to birth. Placental abruption can be either concealed (bleeding remains within the uterus and is not visible) or revealed (visible vaginal bleeding). Risk factorsRisk factors for placental abruption include:4
Clinical featuresHistoryThe typical presentation of placental abruption is sudden constant pain with or without dark red vaginal bleeding (>24 weeks gestation). Other important areas to cover in the history include:
Clinical examinationA digital vaginal examination should not be performed, as this may trigger heavy bleeding in unconfirmed placenta praevia. A careful speculum examination is useful to look for cervical dilatation, ruptured membranes and investigate for infection. Typical clinical findings in placental abruption include:
Fetal wellbeing should be checked with a cardiotocograph (CTG) at 26 weeks gestation or above, otherwise auscultate the fetal heart only. Differential diagnosesPossible differential diagnoses in the context of placental abruption include:
InvestigationsPlacental abruption is a clinical diagnosis and there are no sensitive or reliable diagnostic tests available.5 Bedside investigationsRelevant bedside investigations include:
Laboratory investigationsRelevant laboratory investigations include:
ImagingRelevant imaging investigations include:
ManagementManagement of an antepartum haemorrhage due to placental abruption includes a rapid ABCDE assessment and resuscitation. Maternal resuscitation should not be delayed to determine fetal viability. Definitive management depends on the gestation and presence of fetal distress:
In cases of in-utero fetal death, induced vaginal delivery or caesarean section may be indicated due to maternal compromise. In all cases, anti-D should be administered within 72 hours of the onset of bleeding if the woman is rhesus D negative. ComplicationsMaternal complications of placental abruption include: Fetal complications of placental abruption include: PrognosisPlacental abruption is associated with a high perinatal mortality rate and is responsible for 15% of perinatal deaths. Key points
ReviewerDr Rachel GreenwoodObstetrics & Gynaecology Registrar EditorDr Chris JefferiesReferences
|