Difference between revisions of "Placental abruption"

(Risk Factors)
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===Risk Factors===
 
===Risk Factors===
*Hypertension
+
*[[Hypertension]]- Most common
*Trauma
+
*[[Trauma]]
 
*Smoking
 
*Smoking
 
*Advanced maternal age <ref>Rosen's</ref>
 
*Advanced maternal age <ref>Rosen's</ref>
 
*Multiparity
 
*Multiparity
 +
*[[Preeclampsia]]
 
*Prior placental abruption
 
*Prior placental abruption
 
*Thrombophilia
 
*Thrombophilia
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==Clinical Features==
 
==Clinical Features==
*'''Painful'' vaginal bleeding (may be absent if retro-placental)
+
*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]]
*Nausea and vomiting
+
*[[Nausea and vomiting]]
*Back pain
+
*[[Back pain]]
*Premature labor
+
*[[Premature labor]]
 
*Fetal distress
 
*Fetal distress
 
*Increasing fundal height
 
*Increasing fundal height

Latest revision as of 12:31, 22 February 2020

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