Difference between revisions of "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)
*Must be considered in pts who p/w painful vaginal bleeding near term
+
*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===
 +
*[[Hypertension]]- Most common
 +
*[[Trauma]]
 +
*Smoking
 +
*Advanced maternal age <ref>Rosen's</ref>
 +
*Multiparity
 +
*[[Preeclampsia]]
 +
*Prior placental abruption
 +
*Thrombophilia
 +
*[[Cocaine]] abuse
 +
*History of C-section or other uterine symptoms
  
==Risk Factors==
+
==Clinical Features==
#HTN
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*Painful [[vaginal bleeding]] (may be absent if retro-placental)
#Trauma
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**Characteristically dark and the amount is often insignificant
#Smoking
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**Up to 20% have no vaginal bleeding or pain
#Advanced maternal age
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*Severe uterine/[[pelvic pain]]
#Cocaine abuse
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*Uterine contractions
#History of C-section or other uterine sx
+
*[[Hypotension]]
 +
*[[Nausea and vomiting]]
 +
*[[Back pain]]
 +
*[[Premature labor]]
 +
*Fetal distress
 +
*Increasing fundal height
  
==Diagnosis==
+
==Differential Diagnosis==
*Abruption may be complete, partial, or concealed
+
{{Abdominal Pain Pregnancy DDX}}
**Amount of external bleeding may not correlate with severity
 
*Signs/Symptoms:
 
**Pain vaginal bleeding
 
**Severe uterine pain
 
**Uterine contractions
 
**Hypotension
 
**N/V
 
**Back pain
 
  
==Work-Up==
+
==Evaluation==
#Type + Cross
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*Type & Cross
#CBC
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{{DIC Orders}}
#DIC panel
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*[[Pelvic US]]
#US
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**Specific, not Sensitive (as low as 24% sensitive)
##Sp, not Sn
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**Cannot be used alone to rule-out placental abruption if negative
##Can r/o previa
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**Can rule-out [[placenta previa]]
 +
*If available, obtain fetal heart monitoring
 +
*Consider [[FAST exam]] if trauma
  
==Treatment==
+
==Management==
#Fluid resuscitation
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*[[Fluid resuscitation]]
#Tranfuse blood products (as needed)
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*[[Transfuse blood]] products (as needed)
#Emergent OB/GYN consult
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*Emergent OB/GYN consult
##If unavailable consider C-section in ED
+
**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
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*[[Hemorrhagic shock]]
##DIC
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*[[DIC]]
##Uterine rupture
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*[[Uterine rupture]]
##Multi-organ failure
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*Multi-organ failure
#Neonatal
+
 
##Neurodevelopmental abnormalities
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===Neonatal===
##Death
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*Neurodevelopmental abnormalities
 +
*Death: 67 to 75% rate of fetal mortality
 +
 
 +
==See Also==
 +
*[[Vaginal Bleeding (Main)]]
 +
*[[Trauma in pregnancy]]
  
==Source==
+
==References==
Tintinalli
+
<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