Difference between revisions of "Placental abruption"

m (Rossdonaldson1 moved page Placental Abruption to Placental abruption)
(Risk Factors)
 
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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]]- Most common
#Trauma
+
*[[Trauma]]
#Smoking
+
*Smoking
#Advanced maternal age
+
*Advanced maternal age <ref>Rosen's</ref>
#Cocaine abuse
+
*Multiparity
#History of C-section or other uterine sx
+
*[[Preeclampsia]]
 +
*Prior placental abruption
 +
*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)
*Severe uterine pain
+
**Characteristically dark and the amount is often insignificant
 +
**Up to 20% have no vaginal bleeding or 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
  
==Work-Up==
+
==Differential Diagnosis==
#Type + Cross
+
{{Abdominal Pain Pregnancy DDX}}
#CBC
 
#DIC panel
 
#US
 
##Sp, not Sn (as low as 24% sensitive)
 
##Cannot be used alone to r/o dx if negative
 
##Can r/o previa
 
  
==Treatment==
+
==Evaluation==
#Fluid resuscitation
+
*Type & Cross
#Transfuse blood products (as needed)
+
{{DIC Orders}}
#Emergent OB/GYN consult
+
*[[Pelvic US]]
##If unavailable consider C-section in ED
+
**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==
 
==Complications==
#Maternal
+
===Maternal===
##Hemorrhagic shock
+
*[[Hemorrhagic shock]]
##DIC
+
*[[DIC]]
##Uterine rupture
+
*[[Uterine rupture]]
##Multi-organ failure
+
*Multi-organ failure
#Neonatal
 
##Neurodevelopmental abnormalities
 
##Death - 67 to 75% rate of fetal mortality
 
  
==Source==
+
===Neonatal===
Tintinalli
+
*Neurodevelopmental abnormalities
 +
*Death: 67 to 75% rate of fetal mortality
  
 
==See Also==
 
==See Also==
[[Vaginal Bleeding (Main)]]
+
*[[Vaginal Bleeding (Main)]]
 +
*[[Trauma in pregnancy]]
 +
 
 +
==References==
 +
<references/>
  
[[Category:OB/GYN]]
+
[[Category:OBGYN]]

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