Placental abruption: Difference between revisions

m (Rossdonaldson1 moved page Placental Abruption to Placental abruption)
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**Amount of external bleeding may not correlate with severity
**Amount of external bleeding may not correlate with severity


==Risk Factors==
===Risk Factors===
#HTN
#HTN
#Trauma
#Trauma
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*Fetal distress
*Fetal distress
*Increasing fundal height
*Increasing fundal height
==Differential Diagnosis==
{{Abdominal Pain Pregnancy DDX}}


==Work-Up==
==Work-Up==

Revision as of 19:07, 12 September 2014

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

Differential Diagnosis

Abdominal Pain in Pregnancy

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

<20 Weeks

>20 Weeks

Any time

Work-Up

  1. Type + Cross
  2. CBC
  3. DIC panel
  4. US
    1. Sp, not Sn (as low as 24% sensitive)
    2. Cannot be used alone to r/o dx if negative
    3. 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 - 67 to 75% rate of fetal mortality

Source

Tintinalli

See Also

Vaginal Bleeding (Main)