Feature | Placental Abruption | Placenta Previa | Uterine Rupture |
Signs and Symptoms
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– Onset | Sudden | Often gradual | Sudden |
– Bleeding | Vaginal bleeding (usually dark) | Painless bright red vaginal bleeding | Vaginal bleeding |
– Pain | Severe abdominal pain | Usually, painless | Severe abdominal pain |
– Uterine Activity | Uterine tenderness, contractions/increased uterine tone | Uterus soft and relaxed | Loss of uterine tone |
– Foetal Distress | Foetal distress is common | Foetal distress is less common | Foetal distress is common |
Investigations
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– Initial Investigation | Cardiotocography (CTG) | Ultrasound (preferably transvaginal) | Cardiotocography (CTG) |
– Follow-up Investigation | Vaginal ultrasound (if CTG normal) | None, ultrasound is definitive | Ultrasound or MRI for diagnosis |
Management
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– Immediate Actions | Perform CTG, if foetal distress urgent C-section | Avoid digital or speculum exam until placenta previa is ruled out | Perform CTG, immediate surgical intervention if confirmed |
– Definitive Treatment | Urgent C-section if foetal distress; stabilize mother | Planned C-section if diagnosed; emergency C-section if bleeding | Emergency surgical repair or C-section |
– Monitoring | Continuous foetal monitoring | Continuous foetal monitoring | Continuous foetal monitoring |
– Blood Loss Management | Manage blood loss and stabilize maternal hemodynamic | Blood transfusion if necessary | Manage blood loss and stabilize maternal hemodynamic |