Getting a film with placental abruption (premature separation of placenta from uterus) in the exam is one of the many exam set-pieces that can be prepared for.
Transabdominal and transvaginal pelvic ultrasound show a single live fetus with gestational age of 27 weeks. The cervix is long and closed and the amniotic fluid volume is normal. There is a posterior placenta that is clear of the os. Adjacent to placenta there is a moderated sized, crescentic hypoechoic collection that extends to and lifts a small portion of the placenta edge up. There is a fluid level within the collection and no vascularity is seen on colour Doppler. The findings are in keeping with a subacute marginal placental abruption.
Both ovaries are normal and no adnexal masses seen. I will plot the fetal biometry on a normalised chart to asses for IUGR and arrange follow up scan. I will inform the obstetrician as they may want to admit the patient for bed rest and observation.
- 80% present with vaginal bleeding
- 70% present with pain
- 20% asymptomatic (concealed)
- may be marginal (most common type: 67% of cases over 20 weeks gestation), retroplacental, preplacental (rare)
- variable size but often crescentic
- if more than 50% detachment leads to greater than 50% fetal death rate
- need to start screening a patient with previous abruption 6 weeks before the gestational age of the previous haemorrhage