gynecology and obstetrics
Placental Abruption (Abruptio Placentae)
Diagnosis of Placental Abruption
Fetal heart rate monitoring Sometimes coagulation blood tests Sometimes ultrasonographic findings The diagnosis of placental abruption is suspected if any of the following occur after the 1st trimester: Vaginal bleeding Uterine pain and tenderness Fetal distress or death Hemorrhagic shock DIC Placental abruption should also be considered in women who have had abdominal trauma. If bleeding occurs during middle or late pregnancy, Placenta Previa , which has similar symptoms, must be ruled out before pelvic examination is done; if placenta previa is present, examination may increase bleeding. Evaluation for placental abruption can include the following: Fetal heart monitoring CBC (complete blood count) Blood and Rh typing PT/PTT (prothrombin time/partial thromboplastin time) Serum fibrinogen and fibrin-split products (the most sensitive indicator) Pelvic ultrasonography Kleihauer-Betke test if the patient has Rh-negative blood—to calculate the dose of Rho(D) immune globulin needed The source of bleeding in placental abruption is maternal. However, the partial or complete separation of the placenta from the uterine wall compromises fetal oxygen exchange. Fetal heart rate monitoring may detect a nonreassuring pattern or fetal death. Abnormal results of coagulation blood tests or fetal heart rate monitoring support the diagnosis. Transvaginal ultrasonography is necessary if placenta previa is suspected based on transabdominal ultrasonography. Ultrasonography can show some cases of placental abruption. However, findings with either type of ultrasonography may be normal in placental abruption. Normal ultrasonographic findings do not rule out placental abruption. 