By ULY CLINIC
Placental Abruption
Introduction
It is bleeding from the placental site due to premature separation of a normally situated placenta from 28 weeks of gestation.
Diagnostic Criteria
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Vaginal bleeding: May pass dark blood or clots. Sometimes bleeding can be concealed
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Abdominal pain is moderate to severe but may be absent in small bleeds
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The uterus is enlarged and very tender, painful and sometimes hard
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Fetal demise or fetal distress may be present
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Uterine lower segment tender on vaginal examination
Investigations
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Ultrasound: Fetal wellbeing, localize retro placental clot
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Full blood count and cross–match
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Renal function test and electrolytes
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Liver function tests
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Proteinuria if pre-eclampsia is suspected
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Fibrinogen tests if available
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Coagulation profile
NOTE: The diagnosis of placental abruption is mainly clinical
Management
Maternal resuscitation
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Insert large bore 2 IV lines and give Normal Saline/Ringers Lactate.
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Transfusion if necessary
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Give oxygen 6L/min
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Insert a urinary catheter to monitor input/output
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If Disseminated Intravascular Coagulation: Give fresh frozen Plasma 1 Unit/hour, give packed cells 2–4 units
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Monitor blood pressure, pulse, bleeding, hourly, full blood count, clotting profile every 2 hours
Obstetrical Management
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If the fetus is alive and viable: emergency Caesarean section
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If the fetus is dead: Normal vaginal delivery is preferable
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Perform artificial rupture of membrane,
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If no spontaneous labor: induce with uterotonics (Oxytocin infusion 5IU in dextrose 5% 500 ml beginning with 10 drops/min)
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Do active management of third stage of labor and uterine massage
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Emergency Caesarean section should be considered if:
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Worsening of maternal condition
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Failure/Non progressing vaginal delivery
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Prophylactic antibiotics: Ampicillin IV 2g start, if necessary
Updated on, 3.11.2020
References
1. STG