Difference between revisions of "Placental abruption"

(Source)
(Work-Up)
Line 34: Line 34:
  
 
==Work-Up==
 
==Work-Up==
#Type + Cross
+
*Type + Cross
#CBC
+
*CBC
#DIC panel
+
*DIC panel
#US
+
*[[Pelvic US]]
##Sp, not Sn (as low as 24% sensitive)
+
**Sp, not Sn (as low as 24% sensitive)
##Cannot be used alone to r/o dx if negative  
+
**Cannot be used alone to rule-out placental abruption if negative  
##Can r/o previa
+
**Can rule-out [[placenta previa]]
  
 
==Treatment==
 
==Treatment==

Revision as of 06:17, 20 February 2015

Background

  • 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)
    • Characteristically dark and the amount is often insignificant
    • But up to 20% have no vaginal bleeding or pain
  • 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

Work-Up

  • Type + Cross
  • CBC
  • DIC panel
  • Pelvic US
    • Sp, not Sn (as low as 24% sensitive)
    • Cannot be used alone to rule-out placental abruption if negative
    • Can rule-out placenta previa

Treatment

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

Complications

  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

Sources

  1. Rosen's

See Also

Vaginal Bleeding (Main)