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Radiology
Placental Abruption
Built from Obstetric Imaging
What’s inside
10 sections · 85 slides
Overview
- What this deck covers
What placental abruption is
Definition, and the two ways it presents
- The placenta comes away too early
- Complete or partial separation
- Two ways the placenta can let go
- Revealed and concealed abruption
- Does the blood get out, or not?
- Why abruption matters
How common, and when it happens
Prevalence, trends and gestational age
- How often abruption happens
- 1.2%
- Rates are not moving the same way everywhere
- Abruption is mostly a preterm problem
Who is at risk
One dominant risk factor, and a long list behind it
- The single biggest risk factor
- How to read the risk factor list
- Risk factors grouped as fixed or changeable
- Risk Factors for Placental Abruption
- Risk Factors for Placental Abruption (continued)
- Risk factors that did not hold up
Why the placenta separates
Several routes, one common ending
- There is no single cause
- Four described routes to the same event
- Route 1: a shearing force pulls them apart
- Seat belt position in a car crash
- Route 2: vessels clamp down and tissue dies
- How vessel spasm ends in separation
- Route 3: trouble at the maternal-fetal interface
- Route 4: a problem that started in the first trimester
- The blood tests that fit that theory
- The company abruption keeps
- The final common pathway
- A bleed that keeps itself going
How abruption presents
Symptoms, signs, and what goes wrong
- The classic picture
- What the examination shows
- What the monitors show
- Maternal complications follow the blood loss
- The Couvelaire uterus
- Fetal complications
- When abruption grumbles on
- One thing abruption does not usually cause
What imaging can and cannot do
Ultrasound, MRI, CT and the differential
- What imaging is actually for
- Where the blood collects
- Three places a haematoma can sit
- Why subchorionic blood matters early
- Blood between chorion and uterine wall
- Subchorionic haematoma in a first-trimester twin pregnancy
- Blood collected behind the placenta
- Blood trapped in front of the placenta
- Reading the greys on an ultrasound
- How a clot changes over two weeks
- A resolving clot behind the placenta
- How well ultrasound actually performs
- ~50%
- What a negative scan means
- When the scan does predict outcome
- Scan the fetus too
- MRI: promising, still investigational
- Where MRI genuinely helps
- CT: only when it is already being done
- The jello sign
- What else could this bleeding be?
- Things that mimic a clot on the scan
Managing the pregnancy
Stabilise, decide, and let gestational age guide
- No trial tells you what to do
- The first fork in the road
- First question: is the mother stable?
- Second question: is clotting failing?
- Third question: how is the fetus?
- The bloods to send
- With both stable, gestational age decides
- Two windows, two default plans
- What conservative management involves
- Route of delivery
- After delivery, expect more bleeding
The next pregnancy, and beyond
Recurrence, counselling and lifelong risk
- Abruption repeats
- What to change before the next pregnancy
- Thrombophilia testing is not routine
- Surveillance in the next pregnancy
- A cardiovascular flag for life
Take it away
What the referring physician needs to know
- What the referring physician needs to know
- What the referring physician needs to know (2)
- Key points
- Suggested readings
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition