Difference between revisions of "Placental abruption"

Line 3: Line 3:
 
*Usually occurs spontaneously but also associated w/ trauma (even minor trauma)
 
*Usually occurs spontaneously but also associated w/ trauma (even minor trauma)
 
*Must be considered in pts who p/w painful vaginal bleeding near term
 
*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==
 
==Risk Factors==
Line 12: Line 14:
 
#History of C-section or other uterine sx
 
#History of C-section or other uterine sx
  
==Diagnosis==
+
==Clinical Features==
*Abruption may be complete, partial, or concealed
+
*Painful vaginal bleeding
**Amount of external bleeding may not correlate with severity
+
*Severe uterine pain
*Signs/Symptoms:
+
*Uterine contractions
**Pain vaginal bleeding
+
*Hypotension
**Severe uterine pain
+
*N/V
**Uterine contractions
+
*Back pain
**Hypotension
 
**N/V
 
**Back pain
 
  
 
==Work-Up==
 
==Work-Up==
Line 33: Line 32:
 
==Treatment==
 
==Treatment==
 
#Fluid resuscitation
 
#Fluid resuscitation
#Tranfuse 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

Revision as of 17:56, 1 November 2012

Background

  • Premature separation of placenta from uterus
  • Usually occurs spontaneously but also associated w/ trauma (even minor trauma)
  • 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
  • Severe uterine pain
  • Uterine contractions
  • Hypotension
  • N/V
  • Back pain

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