Concealed abruption in labour — emergency management station

Team-based emergency station: acute concealed placental abruption during labour with fetal bradycardia. Tests recognition of concealed haemorrhage, the differential against uterine rupture, category 1 caesarean with the anaesthetic implication of coagulopathy, transfusion targets, management of the Couvelaire uterus and the postpartum haemorrhage that follows, and structured handover. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

A 28-year-old G2P1 is in spontaneous labour at 39+2 weeks, 6 cm dilated, progressing normally on oxytocin augmentation for slow progress. Over ten minutes she develops severe continuous pain between contractions, the uterus becomes rigid, and the CTG changes from normal to a prolonged deceleration at 70 bpm. There is only a trace of dark blood on the pad. Her blood pressure has fallen from 124/76 to 92/50 mmHg and her pulse has risen from 88 to 132 bpm. You are the registrar; the consultant is in the building.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar on the birth suite. A senior midwife, a student midwife and an anaesthetic registrar are with you; the consultant is in the building and can be at the bedside in three minutes. The assessor runs the clock and feeds you observations and results. ^[1]

Candidate instruction. Lead the management of an acute intrapartum event with a prolonged fetal deceleration and minimal revealed bleeding. Verbalise your working diagnosis, your differential, your actions, your drug orders with doses and your communication with the team, the woman and the consultant. ^[1]^[2]

References7Show

[1]Oyelese Y, Ananth CV Placental abruption Obstet Gynecol, 2006.PMID 17012465
[2]Brandt JS, Ananth CV Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management Am J Obstet Gynecol, 2023.PMID 37164498
[3]Usui R, Matsubara S, Ohkuchi A, et al. Fetal heart rate pattern reflecting the severity of placental abruption Arch Gynecol Obstet, 2008.PMID 17896112
[4]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
[5]Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage J Thromb Haemost, 2007.PMID 17087729
[6]Hiiragi K, Obata S, Miyagi E, Aoki S Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study Int J Gynaecol Obstet, 2025.PMID 39056529
[7]Glantz C, Purnell L Clinical utility of sonography in the diagnosis and treatment of placental abruption J Ultrasound Med, 2002.PMID 12164566

Concealed abruption in labour — emergency management station

Station brief

References7Show

[1]Oyelese Y, Ananth CV Placental abruption Obstet Gynecol, 2006.PMID 17012465
[2]Brandt JS, Ananth CV Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management Am J Obstet Gynecol, 2023.PMID 37164498
[3]Usui R, Matsubara S, Ohkuchi A, et al. Fetal heart rate pattern reflecting the severity of placental abruption Arch Gynecol Obstet, 2008.PMID 17896112
[4]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
[5]Charbit B, Mandelbrot L, Samain E, et al. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage J Thromb Haemost, 2007.PMID 17087729
[6]Hiiragi K, Obata S, Miyagi E, Aoki S Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study Int J Gynaecol Obstet, 2025.PMID 39056529
[7]Glantz C, Purnell L Clinical utility of sonography in the diagnosis and treatment of placental abruption J Ultrasound Med, 2002.PMID 12164566