Difference between revisions of "Placental abruption"

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**Amount of external bleeding may not correlate with severity
**Amount of external bleeding may not correlate with severity
===Risk Factors=== <ref> Rosen's </ref>
===Risk Factors===  
#Advanced maternal age
#Advanced maternal age <ref>Rosen's</ref>
#Prior placental abruption
#Prior placental abruption

Revision as of 05:14, 20 February 2015


  • 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 [1]
  5. Prior placental abruption
  6. Thrombophilia
  7. Cocaine abuse
  8. 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

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

Any time


  1. Type + Cross
  2. CBC
  3. DIC panel
  4. US
    1. Sp, not Sn (as low as 24% sensitive)
    2. Cannot be used alone to r/o dx if negative
    3. Can r/o previa


  1. Fluid resuscitation
  2. Transfuse blood products (as needed)
  3. Emergent OB/GYN consult
    1. If unavailable consider C-section in ED


  1. Maternal
    1. Hemorrhagic shock
    2. DIC
    3. Uterine rupture
    4. Multi-organ failure
  2. Neonatal
    1. Neurodevelopmental abnormalities
    2. Death - 67 to 75% rate of fetal mortality



See Also

Vaginal Bleeding (Main)

  1. Rosen's