Placental abruption

• Placental abruption is a condition where the placenta partially or completely detaches from the uterine wall before delivery.
• This detachment can lead to significant maternal and foetal complications due to the loss of placental blood supply and bleeding.

• Occurs in about 1% of pregnancies but is a leading cause of maternal and foetal morbidity and mortality.
• The condition can happen at any time after the 20th week of gestation, but it is most common in the third trimester.

• Hypertension (chronic or gestational).
• Trauma (e.g., motor vehicle accidents, falls).
• Previous history of placental abruption.
• Cigarette smoking and cocaine use.
• Advanced maternal age.
• Multiparity (having given birth two or more times).
• Premature rupture of membranes.
• Polyhydramnios (excessive amniotic fluid) or multiple gestations.

• Vaginal bleeding (though up to 20% of cases may have concealed bleeding).
• Abdominal pain, which may be constant or intermittent.
• Uterine tenderness and rigidity.
• Foetal distress or decreased foetal movements.
• Back pain.
• Uterine contractions, often with increased frequency and intensity.

• Clinical diagnosis is primarily based on symptoms and physical examination.
• Ultrasound can be used to assess placental position and exclude placenta praevia but may not always detect abruption.
• Monitoring of foetal well-being and maternal status is critical, including foetal heart rate monitoring and assessment of maternal hemodynamic stability.

Immediate Management:

• Stabilisation of the mother’s condition is the first priority, including managing shock and ensuring adequate blood and fluid replacement.
• Foetal monitoring to assess the status of the baby and decide on the timing and mode of delivery.

Delivery:

• Vaginal Delivery: If the foetus is in distress and the mother is stable, vaginal delivery may be attempted with close monitoring.
• Caesarean Section: In cases of severe abruption, foetal distress, or maternal instability, an immediate caesarean section may be necessary.

Postpartum Care:

• Continued monitoring of maternal haemodynamic status and management of bleeding.
• Evaluation for coagulopathies, as disseminated intravascular coagulation (DIC) can be a complication of severe abruption.

• Maternal: Haemorrhage, shock, coagulation disorders, renal failure, and in severe cases, hysterectomy.
• Foetal: Prematurity, intrauterine growth restriction (IUGR), foetal distress, and stillbirth.

• The prognosis depends on the severity of the abruption, gestational age at occurrence, and the speed and effectiveness of the management.
• Early detection and prompt management are key to improving outcomes for both mother and baby.

• Placental abruption is a critical condition that necessitates immediate medical attention to prevent severe complications for both the mother and the foetus.
• The ability to quickly recognise and appropriately respond to signs of placental abruption is crucial in obstetric care.
• Medical students should understand the risk factors, clinical presentation, diagnostic approach, and management principles to effectively contribute to the care of patients with this condition.