Last reviewed: November 2017
Last updated: September  2017

Summary

Definition

History and exam

Key diagnostic factors

  • scarred uterus
  • painless vaginal bleeding
  • absence of cervical/vaginal causes of bleeding on speculum examination

Other diagnostic factors

  • previous ultrasound anomaly in first trimester
  • lack of uterine tenderness
  • low BP and tachycardia

Risk factors

  • advanced maternal age
  • multiple previous pregnancies
  • smoking
  • uterine scarring (most commonly due to prior cesarean section)
  • infertility treatments
  • previous miscarriage
  • previous induced abortion
  • prior placenta previa
  • other placental abnormalities
  • short interpregnancy intervals
  • illicit drug use

Diagnostic investigations

1st investigations to order

  • uterine ultrasound with color flow Doppler analysis
  • CBC
  • type and crossmatch
Full details

Investigations to consider

  • MRI placenta
  • INR/PTT, fibrinogen, and fibrinogen degradation products
  • Kleihauer-Betke test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Janet R. Albers

Professor

Department Chair

Family and Community Medicine

Southern Illinois University School of Medicine

Springfield

IL

Disclosures

JRA declares that she has no competing interests.

Associate Professor

Clinical Family and Community Medicine

Residency Program Director

SIU Quincy Family Medicine

Southern Illinois University

Springfield

IL

Disclosures

THM declares that he has no competing interests.

Dr Janet R. Albers and Dr Thomas H. Miller would like to gratefully acknowledge Dr Robert Ewart and Dr Matthew Hagermeyer, previous contributors to this monograph. RE and MH declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Head of Department of Obstetrics and Gynecology

Mosul College of Medicine

Mosul

Iraq

Disclosures

YTJ declares that he has no competing interests.

Consultant in Family Medicine

Parker D Sanders and Isabella Sanders Professor of Primary Care

Rochester

MN

Disclosures

JB declares that he has no competing interests.

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