Placental abruption: Difference between revisions
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==Background== | ==Background== | ||
[[File:2910 The Placenta-02.jpg|thumb|Normal placental anatomy.]] | |||
*Premature separation of placenta from uterus | *Premature separation of placenta from uterus | ||
*Usually occurs spontaneously but also associated with trauma (even minor trauma) | *Usually occurs spontaneously but also associated with trauma (even minor trauma) | ||
| Line 8: | Line 9: | ||
===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 | ||
| Line 19: | Line 21: | ||
==Clinical Features== | ==Clinical Features== | ||
* | *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 | ||
** | **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 | ||
*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 19:24, 14 December 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
- Hypertension- Most common
- Trauma
- Smoking
- Advanced maternal age [1]
- Multiparity
- Preeclampsia
- Prior placental abruption
- Thrombophilia
- Cocaine abuse
- History of C-section or other uterine symptoms
Clinical Features
- Painful vaginal bleeding (may be absent if retro-placental)
- Characteristically dark and the amount is often insignificant
- Up to 20% have no vaginal bleeding or pain
- Severe uterine/pelvic pain
- Uterine contractions
- Hypotension
- Nausea and vomiting
- 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
- Ectopic pregnancy
- First trimester abortion
- Complete abortion
- Threatened abortion
- Inevitable abortion
- Incomplete abortion
- Missed abortion
- Septic abortion
- Round ligament stretching
- Incarcerated uterus
- Malposition of the uterus
>20 Weeks
- Labor/Preterm labor
- Placental abruption
- Placenta previa
- Vasa previa
- Uterine rupture
- Vaginal trauma
- HELLP syndrome
- Cholestasis of pregnancy
- Chorioamnionitis
- Incarcerated uterus
- Acute fatty liver of pregnancy
- Malposition of the uterus
- Placenta accreta
- Placenta increta
- Placenta percreta
Any time
- Hemorrhagic ovarian cyst
- Fibroid degeneration or torsion
- Ovarian torsion
- Constipation
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
- Hemorrhagic shock
- DIC
- Uterine rupture
- Multi-organ failure
Neonatal
- Neurodevelopmental abnormalities
- Death: 67 to 75% rate of fetal mortality
See Also
References
- ↑ Rosen's