Placental abruption

Background

• Premature separation of placenta from uterus
• Usually occurs spontaneously but also associated w/ trauma (even minor trauma)
• Usually occurs at >15 weeks gestation
• Must be considered in pts who p/w painful vaginal bleeding near term
• Abruption may be complete, partial, or concealed
  • Amount of external bleeding may not correlate with severity

Risk Factors

1. HTN
2. Trauma
3. Smoking
4. Advanced maternal age
5. Cocaine abuse
6. History of C-section or other uterine sx

Clinical Features

• Painful vaginal bleeding (may be absent if retroplacental)
• Severe uterine pain
• Uterine contractions
• Hypotension
• N/V
• Back pain
• Premature labor
• Fetal distress
• Increasing fundal height

Work-Up

1. Type + Cross
2. CBC
3. DIC panel
4. US
   1. Sp, not Sn
   2. Can r/o previa

Treatment

1. Fluid resuscitation
2. Transfuse blood products (as needed)
3. Emergent OB/GYN consult
   1. If unavailable consider C-section in ED

Complications

1. Maternal
   1. Hemorrhagic shock
   2. DIC
   3. Uterine rupture
   4. Multi-organ failure
2. Neonatal
   1. Neurodevelopmental abnormalities
   2. Death

Source

Tintinalli

See Also

Vaginal Bleeding (Main)