Placenta abruption: The Daily PANCE Blueprint
A 20-year-old G2P1 at 33 weeks gestation presents to the ER after a high-speed motor vehicle accident. She was a restrained passenger. She complains of low abdominal discomfort and left ankle pain. The patient is stable, but upon exam, she has tenderness to palpation across the lower abdomen and bright red vaginal bleeding. Which is the most likely diagnosis?
A. Placenta abruption
B. Placenta previa
C. Eclampsia
D. Ectopic pregnancy
E. Placenta accreta
Answer and topic summary
The answer is A. Placenta abruption
Abruptio placentae or placental abruption is defined by premature separation of the normally implanted placenta from the uterine wall, resulting in hemorrhage (usually in pregnancies over 20 weeks of gestation). Risk factors include trauma, preeclampsia, uterine abnormalities, smoking, cocaine, history of placenta abruption, and high parity. Typical presentation on exam would be vaginal bleeding, severe abdominal pain, contractions, and a firm, tender uterus. Labs to order include CBC, CMP, type and cross, Rh, fibrinogen, PT/INR, PTT, Kleihauer-Betke test, and possibly an ultrasound. Management is stabilizing the mom (transfuse blood products, oxygen, fluids), steroids (<34 weeks), mag sulfate (< 32 weeks for CP prophylaxis), serial H/H, and continuous fetal monitoring. Delivery is the definitive treatment. Only minor abruptions should be managed conservatively.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ Blueprint Reproductive System ⇒ ⇒
Also covered as part of the Women's Health EOR and Emergency Medicine PAEA EOR topic list
