Placental abruption in the exam

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
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rID: 22951
Section: Approach
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