Placental abruption

Revision as of 20:21, 20 March 2015 by Snyderjonathan (talk | contribs) (Work-Up)

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 - Fibrinogen, FDP, PT, PTT, D-dimer, blood smear
  • 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
  • Rapid acquisition of Fetal Heart Monitoring, if available

Treatment

Complications

Maternal

Neonatal

  • Neurodevelopmental abnormalities
  • Death: 67 to 75% rate of fetal mortality

Sources

  1. Rosen's

See Also

Vaginal Bleeding (Main)