Difference between revisions of "Placental abruption"

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*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 w/ trauma (even minor trauma)
 +
*Usually occurs at >15 weeks gestation
 
*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
 
*Abruption may be complete, partial, or concealed

Revision as of 22:41, 9 January 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

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)