Difference between revisions of "Placental abruption"

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#HTN
 
#HTN
 
#Trauma
 
#Trauma
##Smoking
+
#Smoking
 
#Advanced maternal age
 
#Advanced maternal age
 
#Cocaine abuse
 
#Cocaine abuse

Revision as of 01:10, 25 August 2011

Background

  • Premature separation of placenta from uterus
  • Usually occurs spontaneously but also associated w/ trauma (even minor trauma)
  • Must be considered in pts who p/w painful vaginal bleeding near term

Risk Factors

  1. HTN
  2. Trauma
  3. Smoking
  4. Advanced maternal age
  5. Cocaine abuse
  6. History of C-section or other uterine sx

Diagnosis

  • Abruption may be complete, partial, or concealed
    • 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

  1. Type + Cross
  2. CBC
  3. DIC panel
  4. US
    1. Sp, not Sn
    2. Can r/o previa

Treatment

  1. Fluid resuscitation
  2. Tranfuse 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

Source

Tintinalli