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Placental abruption is more common than the other
emergencies, with an incidence between 0.5 - 2%
of all pregnancies. Data
from the West Midlands
Abruptio occurs because of premature separation
of a normally sited placenta, with bleeding that
may be concealed (33%) or revealed.
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Incidence is 10 times more likely if there is a previous
history of abruption ( 4),
and 3 times more likely if there is a history of PROM
(5),
smoking or hypertension (2).
Most commonly, abruptio presents with a tender and
tense uterus, bleeding and the start of contractions
(6).
However, beware as the abdomen may be soft if the placenta
is posterior.
A major abruption needs prompt treatment and delivery
to avoid maternal complications and fetal demise.
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Emergency treatment of abruption: (7)
Treat the shock
- Give oxygen
- Insert intravenous lines
- Arrange a cross-match of 6 units of blood
- IV fluids
Deliver the fetus
- By caesarean section (if fetal distress;
fetus viable)
- By rupturing the membranes (if ripe cervix
or fetus nonviable)
Treat DIC
- Urgent haematological consultation
- Check platelet count
- May require FFPs
- Transfusion
Reference: Chamberlain GC. ABC of labour care - Obstetric emergencies.
BMJ 1999;318:1342-5. |
References:
1. Reis PM, Sander CM, Pearlman MD, Abruptio placentae
after auto accidents. A case-control study. J Reprod
Med 2000 Jan;45(1):6-10, Abstract
2. Ananth CV, Smulian JC, Vintzileos AM, Incidence
of placental abruption in relation to cigarette smoking
and hypertensive disorders during pregnancy: a meta-analysis
of observational studies. Obstet Gynecol 1999 Apr;93(4):622-8, Abstract
3. Wiener-Megnagi Z, Ben-Shlomo I, Goldberg Y, Shalev
E, Related Articles, Resistance to activated protein
C and the leiden mutation: high prevalence in patients
with abruptio placentae. Am J Obstet Gynecol 1998 Dec;179(6
Pt 1):1565-7, Abstract
4. Ananth CV. Placental abruption and its association
with hypertension and prolonged rupture of membranes:
a methodological review and meta-analysis. Obstet Gynecol
1996;88(2):309-18, Abstract
5. Major CA. Preterm prolonged rupture of membranes
and abruptio placentae: is there an association between
these pregnancy complications? Am J Obstet Gynecol
1995;172(2 Pt1):672-6
6. Ananth CV. Incidence of placental abruption in
relation to cigarette smoking and hypertensive disorders
during pregnancy: a meta-analysis of observational
studies. Obstet Gynecol 1999;93(4):622-8, Abstract
7. Chamberlain GC. Steer PJ. ABC of labour care. Obstetric
emergencies. BMJ 1999;318:1342, Abstract
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