Placental Abruption: Comprehensive Knowledge and Details

1. Definition:

Placental abruption (PA) is the premature separation of the placenta from the wall of the uterus before the baby is born.

2. Causes:

• Main Cause: High blood pressure during pregnancy, preeclampsia, severe preeclampsia.

• Other Causes:

• Trauma to the abdomen, Cesarean delivery.

• External cephalic version.

• Short umbilical cord.

• Iron deficiency anemia.

• Urinary tract infection.

• Heart failure.

• History of endometrial inflammation.

• Heavy smoking.

• Multiple pregnancies.

3. Classification:

PA is classified according to severity:

• Concealed Abruption: Minimal or no bleeding, mild uterine contractions, minimal impact on the mother’s health.

• Mild Abruption: Minimal bleeding, uterine contractions, stable maternal health.

• Moderate Abruption: Significant bleeding, strong uterine contractions, maternal health is affected.

• Severe Abruption: Heavy bleeding, rigid uterus, severely compromised maternal health.

4. Symptoms:

• Physical Symptoms:

• Rigid uterus, like wood.

• Difficult to feel fetal parts when palpating the abdomen.

• Increased uterine height after two examinations.

• Dark, watery vaginal bleeding, not clotting.

• Sudden abdominal pain.

• Reduced fetal movements.

• Elevated blood pressure.

• Protein in urine.

• Palpating the uterus feels hard like wood.

• Vaginal Examination Symptoms:

• Lower uterine segment is tense.

• Amniotic sac is bulging.

• Amniotic fluid with blood when punctured.

• Paraclinical Symptoms:

• Decreased or normal fibrinogen (mild form).

• Significantly decreased or zero fibrinogen (severe form).

• Ultrasound shows a hematoma behind the placenta.

• Blood count is unchanged or minimally changed.

• Elevated proteinuria.

5. Fetal Heart Rate:

• Mild Abruption: Normal or slow fetal heart rate.

• Severe Abruption: Rapid fetal heart rate distress or fetal death.

6. Notes:

• In PA, the systemic condition doesn’t always correlate with the amount of blood lost through the vagina.

• Bleeding in PA is usually dark, watery, and does not clot.

• The uterus in mild PA remains unchanged.

• The uterus in severe PA becomes rigid, like wood.

7. Differential Diagnosis:

• Placenta Previa: Placenta previa is a condition where the placenta is implanted in the lower part of the uterus, covering the cervix.

• Uterine Rupture: Uterine rupture is a tear in the uterus.

• Threatened Premature Labor: Threatened premature labor is a condition where the cervix dilates prematurely before 37 weeks of gestation.

8. Management:

• Mild Abruption: Treatment to reduce contractions, amniotomy to shorten labor, if progress is slow, early Cesarean delivery is indicated.

• Moderate Abruption: Treatment to reduce contractions, amniotomy, further monitoring.

• Severe Abruption: Maternal resuscitation, Cesarean delivery, uterine preservation or hysterectomy depending on the extent of damage.

• Concealed Abruption: Close monitoring, treatment to reduce contractions, amniotomy, monitoring the mother’s health.

9. Complications:

• For the Mother:

• Hemorrhagic shock.

• Bleeding disorder.

• Kidney failure.

• Couvelaire uterus (uterus turns purple-black).

• For the Fetus:

• Fetal distress.

• Intrauterine fetal demise.

10. Prognosis:

• PA is a dangerous condition that can threaten the lives of both the mother and the fetus.

• The fetal mortality rate is higher in PA compared to other pregnancy complications.

• Maternal mortality can also be high if not treated promptly and effectively.

11. Preventive Measures:

• Good prenatal care, early detection and treatment of high-risk cases like preeclampsia, high blood pressure during pregnancy.

• Minimize risk factors such as abdominal trauma and smoking.

• Deliver in healthcare facilities equipped with adequate equipment and personnel to handle emergencies.

12. Additional Notes:

• PA is an emergency condition requiring prompt and effective treatment.

• Vaginal examinations in PA should be performed with caution to avoid further bleeding.

• Differential diagnosis of PA with other pregnancy complications is crucial.

• The best preventive measure for PA is good prenatal care, early detection, and treatment of high-risk cases.

13. Questions and Answers:

Here are some questions and answers about PA:

• Question: Placental abruption can be a complication of which maternal condition?

• Answer: Severe preeclampsia.

• Question: Which of the following symptoms is NOT found in placental abruption?

• Answer: Uterine tone does not increase.

• Question: In severe placental abruption, what is the pressure inside the amniotic sac?

• Answer: 15-50 mmHg.

• Question: Is placental abruption the placenta detaching?

• Answer: Before the delivery of the baby.

• Question: What kind of bleeding does placental abruption usually cause?

• Answer: Dark, watery blood that doesn’t clot.

• Question: What is a common symptom of placental abruption?

• Answer: Uterus feels hard like wood.

• Question: In mild placental abruption?

• Answer: The uterus has increased tone.

• Question: In severe placental abruption, what is the fetal heart rate?

• Answer: Absent.

• Question: Which of the following conditions is most closely related to the incidence of placental abruption?

• Answer: High blood pressure.

• Question: Which of the following symptoms is NOT true for placental abruption?

• Answer: Fresh, clotted vaginal bleeding.

• Question: Bleeding in the last trimester of pregnancy is usually caused by?

• Answer: Placental abruption, placenta previa, uterine rupture.

• Question: What is the incidence of placental abruption?

• Answer: 0.6-1%.

• Question: What percentage of placental abruption cases have preeclampsia symptoms?

• Answer: 60-70%.

• Question: How much blood loss is possible in mild placental abruption?

• Answer: Minimal or negligible.

• Question: Choose the most accurate answer for a complication of severe placental abruption?

• Answer: Anuria.

• Question: Which of the following symptoms is never present in placental abruption?

• Answer: Bright red vaginal bleeding with clots.

• Question: Which of the following physical symptoms is NOT found in placental abruption?

• Answer: Fetal parts are clearly palpable during abdominal palpation.

• Question: Which of the following symptoms is NOT found during vaginal examination in placental abruption?

• Answer: Rapid cervical effacement and dilation.

• Question: Which of the following paraclinical test changes is NOT found in placental abruption?

• Answer: Fibrinogen levels are always normal.

• Question: Which of the following symptoms is NOT true for concealed placental abruption?

• Answer: Uterus feels hard like wood.

• Question: Mild placental abruption does NOT have which of the following symptoms?

• Answer: Shock.

• Question: Severe placental abruption does NOT have which of the following symptoms?

• Answer: Normal uterine density.

• Question: A patient with placental abruption presenting with minimal bleeding, strong uterine contractions, would be classified as which clinical stage?

• Answer: Mild.

• Question: Moderate placental abruption becomes more dangerous for the mother if?

• Answer: Strong contractions.

• Question: What is the nature of uterine contractions in placental abruption?

• Answer: Strong.

• Question: What is a physical symptom of placental abruption?

• Answer: Increased uterine height.

• Question: Which of the following contributing factors to placental abruption is INCORRECT?

• Answer: Maternal obesity.

• Question: Which of the following conditions is NOT a differential diagnosis for placental abruption?

• Answer: Molar pregnancy.

• Question: What are the common causes of placental abruption?

• Answer: Multiple pregnancies, Trauma, Blood disorders, Previous Cesarean scar, History of endometrial inflammation, Heavy smoking.

• Question: Placental abruption has the following symptoms:

• Answer: Strong, rapid contractions, Uterine segment elongation, Elevated blood pressure, Proteinuria, Bright red bleeding with clots, Increased uterine tone, Dark, watery blood that doesn’t clot, Rigid uterus, Decreased fibrinogen.

• Question: Is fetal heart rate distress a symptom of concealed placental abruption?

• Answer: Incorrect.

• Question: In placental abruption, the systemic condition does not always correlate with the amount of blood lost through the vagina?

• Answer: Correct.

• Question: The uterus in mild placental abruption does not change?

• Answer: Incorrect.

• Question: The uterus in severe placental abruption becomes rigid, like wood?

• Answer: Correct.

• Question: Name 3 causes of bleeding in the last trimester of pregnancy.

• Answer: Placental abruption, Uterine rupture, Placenta previa.

• Question: List the 4 clinical stages of placental abruption.

• Answer: Concealed, Mild, Moderate, Severe.

• Question: When managing severe placental abruption, you need to…and…deliver the baby?

• Answer: Resuscitate, surgically.

• Question: When suspecting placental abruption, which statement about vaginal examination is INCORRECT?

• Answer: It should only be performed in the operating room after resuscitation.

• Question: Placental abruption can occur after?

• Answer: Abdominal trauma, Amniocentesis, External cephalic version.

• Question: Which symptom in placental abruption has the least prognostic value?

• Answer: Dark, watery, non-clotting vaginal bleeding.

• Question: Which clinical stage of placental abruption is most common?

• Answer: Moderate.

• Question: Which of the following contributing factors is often associated with placental abruption?

• Answer: High blood pressure.

• Question: Which substance is responsible for fibrin release?

• Answer: Plasmin.

• Question: What can be assessed during vaginal examination in placental abruption?

• Answer: Cervical firmness and amniotic sac bulge.

• Question: Which statement is incorrect regarding placental abruption diagnosis?

• Answer: Placental abruption can only be diagnosed after delivery with a post-placental hematoma.

• Question: Which statement is most accurate regarding severe placental abruption?

• Answer: It can cause ischemic damage to other organs.

• Question: Which of the following conditions has the highest fetal mortality rate?

• Answer: Placental abruption.

• Question: What causes bleeding in placental abruption?

• Answer: Significant decrease or loss of blood fibrinogen, Disseminated intravascular coagulation, Secondary fibrinolysis.

• Question: What are the characteristics of the pathological lesions in the uterus and other internal organs in placental abruption?

• Answer: They are not consistent with the severity of the clinical presentation.

• Question: Which of the following symptoms is incorrect for differentiating placental abruption from placenta previa?

• Answer: The amount of vaginal bleeding.

• Question: Choose the correct statement regarding paraclinical tests for placental abruption.

• Answer: Paraclinical tests are more valuable for prognosis than diagnosis.

• Question: Which statement is INCORRECT about severe placental abruption?

• Answer: It is always accompanied by heart failure.

• Question: What is the main purpose of amniotomy in placental abruption?

• Answer: To reduce amniotic sac pressure.

• Question: List two maternal complications of placental abruption.

• Answer: Hemorrhagic shock, Bleeding disorder.

• Question: Choose one correct statement about severe placental abruption.

• Answer: It can cause infarction in the uterus, fallopian tubes, ovaries…

• Question: Which complication of placental abruption is rare?

• Answer: Adrenal insufficiency.

• Question: What is the initial management for Couvelaire uterus?

• Answer: Maternal resuscitation, Cesarean delivery, uterine preservation or hysterectomy depending on the extent of damage.

• Question: What is the first step in managing placental abruption after the baby is delivered?

• Answer: Stimulate contractions with uterotonic medications.

• Question: Which management approach is incorrect in mild placental abruption?

• Answer: Cesarean delivery.

• Question: What is the best preventative measure for placental abruption?

• Answer: Good prenatal care and identifying high-risk pregnancies.

Note: The information provided is for reference only. Consult with a physician for personalized advice and treatment.