Placental abruption: Difference between revisions
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**Amount of external bleeding may not correlate with severity | **Amount of external bleeding may not correlate with severity | ||
===Risk Factors=== | ===Risk Factors=== | ||
#HTN | #HTN | ||
#Trauma | #Trauma | ||
#Smoking | #Smoking | ||
#Advanced maternal age | #Advanced maternal age <ref>Rosen's</ref> | ||
#Prior placental abruption | #Prior placental abruption | ||
#Thrombophilia | #Thrombophilia | ||
Revision as of 05:14, 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
- HTN
- Trauma
- Smoking
- Advanced maternal age [1]
- Prior placental abruption
- Thrombophilia
- Cocaine abuse
- History of C-section or other uterine sx
Clinical Features
- Painful vaginal bleeding (may be absent if retroplacental)
- 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
- 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
Work-Up
- Type + Cross
- CBC
- DIC panel
- US
- Sp, not Sn (as low as 24% sensitive)
- Cannot be used alone to r/o dx if negative
- Can r/o previa
Treatment
- Fluid resuscitation
- Transfuse blood products (as needed)
- Emergent OB/GYN consult
- If unavailable consider C-section in ED
Complications
- Maternal
- Hemorrhagic shock
- DIC
- Uterine rupture
- Multi-organ failure
- Neonatal
- Neurodevelopmental abnormalities
- Death - 67 to 75% rate of fetal mortality
Source
Tintinalli
See Also
- ↑ Rosen's