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Q1: Diagnosis (2 min)
"How does placental abruption present?"
- SEVERE CONSTANT abdominal pain + dark vaginal bleeding
- Uterus HARD, WOODY, TENDER (does not relax)
- Fetal distress or intrauterine death
- Pre-eclampsia often present (strongest risk factor)
- Shock may be disproportionate to visible bleeding (concealed)
Q2: vs praevia (2 min)
"Distinguish abruption from praevia."
- Abruption: PAINFUL, dark blood, HARD uterus, distress, pre-eclampsia
- Praevia: PAINLESS, bright red, SOFT uterus, normal FH, previous C-section
Q3: Management (3 min)
"How do you manage severe abruption?"
- Resuscitate: ABC, fluids, crossmatch
- Correct DIC: cryoprecipitate (fibrinogen), platelets, FFP
- Fetus alive + distress: EMERGENCY C-SECTION
- Fetus dead: VAGINAL DELIVERY (avoid surgery in coagulopathic patient)
- Postpartum: watch for PPH (Couvelaire uterus)
Q4: Complications (2 min)
"What complications can occur?"
- Fetal death (10 to 30%)
- DIC (thromboplastin release)
- Couvelaire uterus (blood in muscle → atonic PPH)
- Acute kidney injury (cortical necrosis)
- Sheehan syndrome (pituitary infarction)
- Recurrence 6 to 25%