Placental abruption - Revision history

Danbot: Strip excess bold

2026-03-22T09:35:27Z

Strip excess bold

← Revisión anterior		Revisión del 09:35 22 mar 2026
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	==Clinical Features==		==Clinical Features==
	*~~'''~~Painful~~'''~~ vaginal bleeding (contrast with painless bleeding of [[Placenta previa\|previa]])		*Painful vaginal bleeding (contrast with painless bleeding of [[Placenta previa\|previa]])
	*~~'''~~Rigid, tender uterus~~'''~~ ("board-like" in severe cases)		*Rigid, tender uterus ("board-like" in severe cases)
	*Uterine contractions or hypertonicity		*Uterine contractions or hypertonicity
	*Fetal distress (decelerations, bradycardia) or fetal demise		*Fetal distress (decelerations, bradycardia) or fetal demise
	*~~'''~~Concealed abruption~~'''~~: hemodynamic instability with minimal external bleeding		*Concealed abruption: hemodynamic instability with minimal external bleeding
	*Signs of [[Hemorrhagic shock\|hemorrhagic shock]]: tachycardia, hypotension		*Signs of [[Hemorrhagic shock\|hemorrhagic shock]]: tachycardia, hypotension
	*May trigger [[DIC]] (present in ~10-20% of severe cases)		*May trigger [[DIC]] (present in ~10-20% of severe cases)
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	==Evaluation==		==Evaluation==
	*~~'''~~Clinical diagnosis~~'''~~ primarily — ultrasound has ~~'''~~low sensitivity~~'''~~ (~25-50%) for abruption<ref name="glantz">Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. ''J Ultrasound Med''. 2002;21(8):837-840. PMID 12164566.</ref>		*Clinical diagnosis primarily — ultrasound has low sensitivity (~25-50%) for abruption<ref name="glantz">Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. ''J Ultrasound Med''. 2002;21(8):837-840. PMID 12164566.</ref>
	*~~'''~~Labs~~'''~~		*Labs
	**CBC (may show anemia; serial Hgb)		**CBC (may show anemia; serial Hgb)
	**Type and screen / crossmatch		**Type and screen / crossmatch
	**Coagulation studies: PT, PTT, fibrinogen (~~'''~~fibrinogen <200 mg/dL is concerning; <100 suggests severe DIC~~'''~~)		**Coagulation studies: PT, PTT, fibrinogen (fibrinogen <200 mg/dL is concerning; <100 suggests severe DIC)
	**D-dimer		**D-dimer
	**[[Kleihauer-Betke test]] (quantify fetomaternal hemorrhage, especially if Rh-negative)		**[[Kleihauer-Betke test]] (quantify fetomaternal hemorrhage, especially if Rh-negative)
	**BMP (renal function)		**BMP (renal function)
	*~~'''~~Fetal monitoring~~'''~~ — continuous cardiotocography		*Fetal monitoring — continuous cardiotocography
	*~~'''~~Ultrasound~~'''~~ — useful to rule out [[Placenta previa]] but cannot reliably exclude abruption		*Ultrasound — useful to rule out [[Placenta previa]] but cannot reliably exclude abruption

	==Management==		==Management==
	===Unstable / Severe Abruption===		===Unstable / Severe Abruption===
	*Aggressive IV fluid resuscitation, [[Massive transfusion protocol\|massive transfusion protocol]]		*Aggressive IV fluid resuscitation, [[Massive transfusion protocol\|massive transfusion protocol]]
	*~~'''~~Emergent cesarean delivery~~'''~~ if fetal distress or maternal instability		*Emergent cesarean delivery if fetal distress or maternal instability
	*Treat [[DIC]] with blood products (FFP, cryoprecipitate, platelets)		*Treat [[DIC]] with blood products (FFP, cryoprecipitate, platelets)
	*Target fibrinogen >150-200 mg/dL		*Target fibrinogen >150-200 mg/dL
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	==Disposition==		==Disposition==
	*~~'''~~All patients with suspected abruption require admission~~'''~~		*All patients with suspected abruption require admission
	*Emergent OB/GYN consultation		*Emergent OB/GYN consultation
	*ICU if hemodynamically unstable or DIC		*ICU if hemodynamically unstable or DIC

Danbot: Major expansion: concealed abruption, fibrinogen thresholds, DIC management, low US sensitivity, references

2026-03-21T18:34:50Z

Major expansion: concealed abruption, fibrinogen thresholds, DIC management, low US sensitivity, references

← Revisión anterior		Revisión del 18:34 21 mar 2026
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	==Background==		==Background==
	~~[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]~~		*Premature separation of a normally implanted placenta from the uterine wall
	*Premature separation of placenta from ~~uterus~~		*Occurs in 0.4-1% of pregnancies<ref name="tikkanen">Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. ''Acta Obstet Gynecol Scand''. 2011;90(2):140-149. PMID 21241259.</ref>
	*~~Usually occurs spontaneously but also associated with trauma~~ (~~even minor trauma~~)		*Significant cause of third-trimester hemorrhage, fetal distress, and maternal morbidity
	*~~Usually occurs at >15 weeks gestation~~		*Maternal mortality ~1%; fetal mortality 15-20%
	*~~Must be considered in patients who presenting with painful vaginal bleeding near term~~		*Abruption may be concealed (hemorrhage trapped behind placenta) with minimal vaginal bleeding
	*Abruption may be ~~complete, partial, or~~ concealed
	**Amount of external bleeding ~~may not correlate with severity~~

	===Risk Factors===		==Risk Factors==
	*[[~~Hypertension~~]]- ~~Most~~ common		*Hypertension / [[Preeclampsia]]
	*[[~~Trauma~~]]		*Prior abruption (10-15% recurrence)
			*Trauma (including [[Motor vehicle collision\|MVC]] — most common cause of traumatic abruption)
			*[[Cocaine]] use
	*Smoking		*Smoking
	*Advanced maternal age ~~<ref>Rosen's</ref>~~		*Advanced maternal age
	*~~Multiparity~~		*Premature rupture of membranes
	*[[Preeclampsia]]		*Short umbilical cord
	*Prior placental abruption
	*Thrombophilia
	*~~[[Cocaine]] abuse~~
	*History of C-section or other uterine symptoms

	==Clinical Features==		==Clinical Features==
	*Painful [[vaginal bleeding]] (~~may be absent if retro-placental)~~		*'''Painful''' vaginal bleeding (contrast with painless bleeding of [[Placenta previa\|previa]])
	**Characteristically dark and the amount is often insignificant		*'''Rigid, tender uterus''' ("board-like" in severe cases)
	**Up to 20% have no vaginal bleeding ~~or pain~~		*Uterine contractions or hypertonicity
	*Severe uterine/[[~~pelvic pain~~]]		*Fetal distress (decelerations, bradycardia) or fetal demise
	*Uterine contractions		*'''Concealed abruption''': hemodynamic instability with minimal external bleeding
	*~~[[Hypotension]]~~		*Signs of [[Hemorrhagic shock\|hemorrhagic shock]]: tachycardia, hypotension
	*~~[[Nausea and vomiting]]~~		*May trigger [[DIC]] (present in ~10-20% of severe cases)
	*[[~~Back pain~~]]
	*[[~~Premature labor~~]]
	*Fetal distress
	*Increasing fundal height

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*~~Type & Cross~~		*'''Clinical diagnosis''' primarily — ultrasound has '''low sensitivity''' (~25-50%) for abruption<ref name="glantz">Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. ''J Ultrasound Med''. 2002;21(8):837-840. PMID 12164566.</ref>
	*~~CBC~~		*'''Labs'''
	*~~Platelets~~		**CBC (may show anemia; serial Hgb)
	*~~PT/INR~~		**Type and screen / crossmatch
	*~~PTT~~		**Coagulation studies: PT, PTT, fibrinogen ('''fibrinogen <200 mg/dL is concerning; <100 suggests severe DIC''')
	*~~Fibrinogen~~		**D-dimer
	** ~~Strongly correlates with severity of hemorrhage~~ (≤ 200 mg/dL ~~has~~ 100~~% PPV for~~ severe ~~bleed~~)		**[[Kleihauer-Betke test]] (quantify fetomaternal hemorrhage, especially if Rh-negative)
	*[[D-dimer]]		**BMP (renal function)
	*~~Fibrin Degraded Products~~		*'''Fetal monitoring''' — continuous cardiotocography
	*[[~~Pelvic US~~]]		*'''Ultrasound''' — useful to rule out [[Placenta previa]] but cannot reliably exclude abruption
	**~~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==		==Management==
	*[[~~Fluid resuscitation~~]]		===Unstable / Severe Abruption===
	*[[~~Transfuse blood~~]] products (~~as needed~~)		*Aggressive IV fluid resuscitation, [[Massive transfusion protocol\|massive transfusion protocol]]
	*~~Emergent~~ OB/GYN ~~consult~~		*'''Emergent cesarean delivery''' if fetal distress or maternal instability
	**If unavailable consider C-section in ED		*Treat [[DIC]] with blood products (FFP, cryoprecipitate, platelets)
	*Consider minimum 6 hours observation even if abruption not identified, if mechanism is concerning		*Target fibrinogen >150-200 mg/dL
			*OB/GYN emergent consultation

	==~~Complications~~==		===Stable / Mild Abruption===
	~~===Maternal~~===		*Admit to labor and delivery
	*~~[[Hemorrhagic shock]]~~		*Continuous fetal monitoring
	*[[~~DIC~~]]		*Serial labs (Hgb, fibrinogen, coagulation studies)
	*[[~~Uterine rupture~~]]		*If preterm: antenatal corticosteroids ([[Betamethasone]]) for fetal lung maturity
	*~~Multi-organ failure~~		*[[RhoGAM]] if Rh-negative
			*Expectant management may be appropriate if fetus is preterm and both mother and fetus are stable

	==~~=Neonatal=~~==		==Disposition==
	*~~Neurodevelopmental abnormalities~~		*'''All patients with suspected abruption require admission'''
	*~~Death: 67 to 75% rate of fetal mortality~~		*Emergent OB/GYN consultation
			*ICU if hemodynamically unstable or DIC

	==See Also==		==See Also==
			*[[Placenta previa]]
	*[[Vaginal Bleeding (Main)]]		*[[Vaginal Bleeding (Main)]]
	*[[~~Trauma in pregnancy~~]]		*[[Postpartum hemorrhage]]
			*[[DIC]]
			*[[Preeclampsia]]

	==References==		==References==

Rossdonaldson1: /* Background */

2022-12-14T19:24:52Z

Background

← Revisión anterior		Revisión del 19:24 14 dic 2022
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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)

Peter.eyermann: /* Evaluation */

2022-08-08T17:48:39Z

Evaluation

← Revisión anterior		Revisión del 17:48 8 ago 2022
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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)

Alexgrohmann: /* Risk Factors */

2020-02-22T12:31:21Z

Risk Factors

← Revisión anterior		Revisión del 12:31 22 feb 2020
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	===Risk Factors===		===Risk Factors===
	*[[Hypertension]]		*[[Hypertension]]- Most common
	*[[Trauma]]		*[[Trauma]]
	*Smoking		*Smoking

ClaireLewis at 02:03, 4 October 2019

2019-10-04T02:03:54Z

← Revisión anterior		Revisión del 02:03 4 oct 2019
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	===Risk Factors===		===Risk Factors===
	*Hypertension		*[[Hypertension]]
	*Trauma		*[[Trauma]]
	*Smoking		*Smoking
	*Advanced maternal age <ref>Rosen's</ref>		*Advanced maternal age <ref>Rosen's</ref>
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	*[[Nausea and vomiting]]		*[[Nausea and vomiting]]
	*[[Back pain]]		*[[Back pain]]
	*Premature labor		*[[Premature labor]]
	*Fetal distress		*Fetal distress
	*Increasing fundal height		*Increasing fundal height

ClaireLewis: /* Clinical Features */

2019-08-31T01:07:18Z

Clinical Features

← Revisión anterior		Revisión del 01:07 31 ago 2019
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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
	**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

Kxl328: /* Risk Factors */

2018-10-13T19:40:25Z

Risk Factors

← Revisión anterior		Revisión del 19:40 13 oct 2018
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	*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

Spenceemmett: /* Clinical Features */

2018-09-16T04:19:55Z

Clinical Features

← Revisión anterior		Revisión del 04:19 16 sep 2018
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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 pain
	*Uterine contractions		*Uterine contractions

Spenceemmett: /* Risk Factors */

2018-09-16T04:19:06Z

Risk Factors

← Revisión anterior		Revisión del 04:19 16 sep 2018
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	===Risk Factors===		===Risk Factors===
	*~~hypertension~~		*Hypertension
	*Trauma		*Trauma
	*Smoking		*Smoking
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	*Prior placental abruption		*Prior placental abruption
	*Thrombophilia		*Thrombophilia
	*[[Cocaine]]abuse		*[[Cocaine]] abuse
	*History of C-section or other uterine symptoms		*History of C-section or other uterine symptoms