Placental abruption: Difference between revisions

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


===Risk Factors===  
===Risk Factors===
#HTN
*[[Hypertension]]
#Trauma
*[[Trauma]]
#Smoking
*Smoking
#Advanced maternal age <ref>Rosen's</ref>
*Advanced maternal age <ref>Rosen's</ref>
#Prior placental abruption
*Multiparity
#Thrombophilia
*[[Preeclampsia]]
#Cocaine abuse
*Prior placental abruption
#History of C-section or other uterine sx
*Thrombophilia
*[[Cocaine]] abuse
*History of C-section or other uterine symptoms


==Clinical Features==
==Clinical Features==
*Painful vaginal bleeding (may be absent if retroplacental)
*Painful [[vaginal bleeding]] (may be absent if retro-placental)
**Characteristically dark and the amount is often insignificant  
**Characteristically dark and the amount is often insignificant  
**But up to 20% have no vaginal bleeding or pain
**Up to 20% have no vaginal bleeding or pain
*Severe uterine pain
*Severe uterine/[[pelvic pain]]
*Uterine contractions
*Uterine contractions
*Hypotension
*[[Hypotension]]
*N/V
*[[Nausea and vomiting]]
*Back pain
*[[Back pain]]
*Premature labor
*[[Premature labor]]
*Fetal distress
*Fetal distress
*Increasing fundal height
*Increasing fundal height
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{{Abdominal Pain Pregnancy DDX}}
{{Abdominal Pain Pregnancy DDX}}


==Work-Up==
==Evaluation==
*Type + Cross
*Type & Cross
*CBC
{{DIC Orders}}
*DIC panel - Fibrinogen, FDP, PT, PTT, D-dimer, blood smear
*[[Pelvic US]]
*[[Pelvic US]]
**Sp, not Sn (as low as 24% sensitive)
**Specific, not Sensitive (as low as 24% sensitive)
**Cannot be used alone to rule-out placental abruption if negative  
**Cannot be used alone to rule-out placental abruption if negative  
**Can rule-out [[placenta previa]]
**Can rule-out [[placenta previa]]
*Rapid acquisition of Fetal Heart Monitoring, if available
*If available, obtain fetal heart monitoring
*Consider [[FAST exam]] if trauma


==Treatment==
==Management==
*[[Fluid resuscitation]]
*[[Fluid resuscitation]]
*[[Transfuse blood]] products (as needed)
*[[Transfuse blood]] products (as needed)
*Emergent OB/GYN consult
*Emergent OB/GYN consult
**If unavailable consider C-section in ED
**If unavailable consider C-section in ED
*Consider minimum 6 hours observation even if abruption not identified, if mechanism is concerning


==Complications==
==Complications==
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*Death: 67 to 75% rate of fetal mortality
*Death: 67 to 75% rate of fetal mortality


==Sources==
==See Also==
*[[Vaginal Bleeding (Main)]]
*[[Trauma in pregnancy]]
 
==References==
<references/>
<references/>


==See Also==
[[Category:OBGYN]]
[[Vaginal Bleeding (Main)]]
 
[[Category:OB/GYN]]

Revision as of 02:03, 4 October 2019

Background

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

Risk Factors

Clinical Features

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time

Evaluation

  • Type & Cross
  • CBC
  • Platelets
  • PT/INR
  • PTT
  • Fibrinogen
  • D-dimer
  • Fibrin Degraded Products
  • Pelvic US
    • Specific, not Sensitive (as low as 24% sensitive)
    • Cannot be used alone to rule-out placental abruption if negative
    • Can rule-out placenta previa
  • If available, obtain fetal heart monitoring
  • Consider FAST exam if trauma

Management

  • Fluid resuscitation
  • Transfuse blood products (as needed)
  • Emergent OB/GYN consult
    • If unavailable consider C-section in ED
  • Consider minimum 6 hours observation even if abruption not identified, if mechanism is concerning

Complications

Maternal

Neonatal

  • Neurodevelopmental abnormalities
  • Death: 67 to 75% rate of fetal mortality

See Also

References

  1. Rosen's