Placental Abruption

A placental abruption can become life-threatening before the amount of blood on a pad looks alarming. Blood may collect behind the placenta rather than exit through the vagina, while the pregnant person develops shock and the fetus loses placental oxygenation. Treat the haemorrhage, fetal compromise and risk of coagulopathy as parallel problems. Hold one picture in your mind. The placenta is the fetal lung, and it works only while it stays attached to the uterine wall. When maternal vessels bleed behind it, three things happen at once: the mother loses blood, the fetus loses gas-exchange surface, and injured placental tissue switches on maternal clotting. Each finding at the bedside belongs to one of those three problems, and none of them waits for the others. The process begins when maternal decidual vessels rupture. A retroplacental haematoma then shears the placenta away from the uterine wall. Placental and decidual tissue factor enters the maternal circulation, producing rapid thrombin generation and consumption of fibrinogen and other clotting factors. This is why a patient with abruption can develop disseminated intravascular coagulation (DIC) before measured...