Difference between revisions of "Placental abruption"

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(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===  
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===Risk Factors===
#HTN
+
*[[Hypertension]]- Most common
#Trauma
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*[[Trauma]]
#Smoking
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*Smoking
#Advanced maternal age <ref>Rosen's</ref>
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*Advanced maternal age <ref>Rosen's</ref>
#Prior placental abruption
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*Multiparity
#Thrombophilia
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*[[Preeclampsia]]
#Cocaine abuse
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*Prior placental abruption
#History of C-section or other uterine sx
+
*Thrombophilia
 +
*[[Cocaine]] abuse
 +
*History of C-section or other uterine symptoms
  
 
==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
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**Up to 20% have no vaginal bleeding or pain
*Severe uterine pain
+
*Severe uterine/[[pelvic pain]]
 
*Uterine contractions
 
*Uterine contractions
*Hypotension
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*[[Hypotension]]
*Nausea and vomiting
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*[[Nausea and vomiting]]
*Back pain
+
*[[Back pain]]
*Premature labor
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*[[Premature labor]]
 
*Fetal distress
 
*Fetal distress
 
*Increasing fundal height
 
*Increasing fundal height
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{{Abdominal Pain Pregnancy DDX}}
 
{{Abdominal Pain Pregnancy DDX}}
  
==Diagnosis==
+
==Evaluation==
 
*Type & Cross
 
*Type & Cross
{{Template:DIC Orders}}
+
{{DIC Orders}}
 
*[[Pelvic US]]
 
*[[Pelvic US]]
**Sp, not Sn (as low as 24% sensitive)
+
**Specific, not Sensitive (as low as 24% sensitive)
 
**Cannot be used alone to rule-out placental abruption if negative  
 
**Cannot be used alone to rule-out placental abruption if negative  
 
**Can rule-out [[placenta previa]]
 
**Can rule-out [[placenta previa]]
 
*If available, obtain fetal heart monitoring
 
*If available, obtain fetal heart monitoring
*Consider [[Ultrasound: FAST]] if trauma
+
*Consider [[FAST exam]] if trauma
  
==Treatment==
+
==Management==
 
*[[Fluid resuscitation]]
 
*[[Fluid resuscitation]]
 
*[[Transfuse blood]] products (as needed)
 
*[[Transfuse blood]] products (as needed)
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*Death: 67 to 75% rate of fetal mortality
 
*Death: 67 to 75% rate of fetal mortality
  
==Sources==
+
==See Also==
 +
*[[Vaginal Bleeding (Main)]]
 +
*[[Trauma in pregnancy]]
 +
 
 +
==References==
 
<references/>
 
<references/>
  
==See Also==
+
[[Category:OBGYN]]
[[Vaginal Bleeding (Main)]]
 
 
 
[[Category:OB/GYN]]
 

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