Clinical Manifestations/Findings:

Consequences/Complications:

Management:

Vaginal bleeding, abdominal pain accompanied by uterine contractions including tachysystole, uterine tenderness, nonreassuring fetal heart rate pattern

Maternal

Excessive blood loss, DIC, both leading to hypovolemic shock, AKI, ARDS, multiorgan failure, peripartum hysterectomy and death

-Immediate continuous FHR monitoring, IV access establishment, keep patients warm, supplemental O2 use as necessary, attempt quantification of blood loss, lab testing of CBC, type and screen, crossmatch as necessary, coagulation studies, liver studies,

US finding of retroplacental hematoma has a PPV of ~90%, but has low sensitivity 25% - 60%

Postpartum consequences include increased long-term risk of premature CV disease and increased mortality at earlier age

Replacement with blood products as necessary, with targets as follows: hematocrit > 25% - 30%, platelet count > 75,000, fibrinogen > 300 mg/dL, PT and aptt < 1.5x control

Fetal:

-Increased perinatal morbidity and mortality related to hypoxemia, asphyxia, low birth weight and/or preterm birth

**perinatal mortality ~3% - 12%

Ultimately cesarean section may be needed to control issue and protect both mother and fetus