Placental abruption: Difference between revisions

 
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===Risk Factors===
===Risk Factors===
*Hypertension
*[[Hypertension]]- Most common
*Trauma
*[[Trauma]]
*Smoking
*Smoking
*Advanced maternal age <ref>Rosen's</ref>
*Advanced maternal age <ref>Rosen's</ref>
*Multiparity
*Multiparity
*[[Preeclampsia]]
*Prior placental abruption
*Prior placental abruption
*Thrombophilia
*Thrombophilia
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==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
**Up to 20% have no vaginal bleeding or pain
*Severe uterine pain
*Severe uterine/[[pelvic pain]]
*Uterine contractions
*Uterine contractions
*Hypotension
*[[Hypotension]]
*Nausea and vomiting
*[[Nausea and vomiting]]
*Back pain
*[[Back pain]]
*Premature labor
*[[Premature labor]]
*Fetal distress
*Fetal distress
*Increasing fundal height
*Increasing fundal height
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==Evaluation==
==Evaluation==
*Type & Cross
*Type & Cross
{{DIC Orders}}
*CBC
*Platelets
*PT/INR
*PTT
*Fibrinogen
** Strongly correlates with severity of hemorrhage (≤ 200 mg/dL has 100% PPV for severe bleed)
*[[D-dimer]]
*Fibrin Degraded Products
*[[Pelvic US]]
*[[Pelvic US]]
**Specific, not Sensitive (as low as 24% sensitive)
**Specific, not Sensitive (as low as 24% sensitive)

Latest revision as of 17:48, 8 August 2022

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
    • Strongly correlates with severity of hemorrhage (≤ 200 mg/dL has 100% PPV for severe bleed)
  • 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