ob.placental-abruption.v1

Placental Abruption / Abruptio Placentae

obstetricsacuteadultpregnancyacuteinpatient

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NEW Phase C dossier — authored 2026-05-15 for shard-5-obped-id. Covers placental abruption / abruptio placentae — premature separation of normally implanted placenta from uterine wall before delivery. Incidence 0.6-1% of all pregnancies (Tikkanen 2011 PMID 21241259); recurrence 15-25% in subsequent pregnancy; fetal mortality ~ 12% overall up to 50% if Sher grade 3; maternal mortality < 1% in high-resource settings. Diagnosis is largely CLINICAL — US sensitivity for retroplacental clot only 25-60% (Glantz Purnell 2002 PMID 12164566); non-visualisation does NOT rule out. Seed manifest authored at prisma/seed/manifests/ob.placental-abruption.v1.ts (defineBatch23ScaffoldManifest routing scaffold; ICD-10 / SNOMED / LOINC terminology anchors projected 1:1 from this dossier terminology block, no new codes invented) and pointed to by the manifest field. Dossier promoted PLANNED → INTEGRATED on 2026-05-25. _registry.ts NOT modified per refined shard-5 pattern (3-file set only: dossier TS + brief + research bundle). Registry edit deferred to a future shard. Distinct from ob.postpartum-hemorrhage.core.v1 (sibling — abruption is a known atony + DIC antecedent; sequential / overlapping presentation), ob.pre-eclampsia.core.v1 (sibling — PE is strongest single risk factor for abruption; overlap drives concurrent PE-protocol with methylergonovine contraindication), ob.chorioamnionitis.v1 (sibling — PROM + chorio is antecedent abruption risk factor; co-present with delivery indication), id.sepsis.core.v1 (sibling — shared resuscitation framework; chorio + abruption + sepsis can co-present). Sibling differentiation explicitly encoded for all four. Phenotype matrix (9-axis type × Sher grade × GA × cause × maternal-stable × fetal-distress × DIC × prior-abruption × multiple-gestation cross-product — thousands of cells collapsed to 10 anchor combinations) encoded indirectly via regimen_axes.placental_abruption_acute_management.steps (expectant_preterm_stable / emergent_delivery_unstable / dic_massive_transfusion / rh_negative_rhogam / chorio_overlap_antibiotics / antihypertensive_for_severe_HTN_overlap) + severity_triggers (10 phenotype-specific triggers) + setting playbooks (ed / inpatient / icu / outpatient). First-class TS phenotype field is schema-blocked. Severity triggers (10): placental_abruption_with_maternal_instability (life_threatening — emergent delivery + MTP + ICU; do NOT delay for imaging), placental_abruption_with_fetal_distress (life_threatening — emergent cesarean if viable GA + alive fetus + parental wishes aligned), placental_abruption_grade_3_with_dic (life_threatening — Sher 3 + DIC; MTP + cryoprecipitate + FFP + platelets; hysterectomy if uncontrolled), abruption_with_pre_eclampsia_overlap (severe — magnesium + antihypertensive titration + methylergonovine CI), cocaine_methamphetamine_associated_abruption (severe — UDS + addiction medicine + recurrence prevention), trauma_associated_abruption (severe — ATLS + 4 h EFM + KB + IPV screening + level-1 trauma referral if severe), preterm_abruption_with_expectant_management (severe — steroids + magnesium + inpatient surveillance; outpatient typically NOT appropriate), recurrent_abruption_in_subsequent_pregnancy (severe — recurrence 15-25%; preconception MFM + low-dose aspirin + thrombophilia workup if recurrent), concealed_abruption_with_hypovolemic_signs_despite_minimal_bleed (severe — hidden retroplacental clot; emergent imaging + delivery), kleihauer_betke_with_fetomaternal_hemorrhage (severe — RhoGAM dose-adjustment + consider intrauterine transfusion). Bayesian linkage (per §5.5.2): pre-test priors documented in _research-bundles/ob.placental-abruption.v1.md — abruption ~ 0.6-1% of pregnancies overall (Tikkanen 2011); recurrence ~ 15-25% in subsequent pregnancy; fetal mortality ~ 12% overall, up to 50% if Sher grade 3; maternal mortality < 1% in high-resource settings; pregnancies with chronic HTN have ~ 3-5x baseline risk. Key LRs: painful vaginal bleeding + tetanic contractions LR+ ~ 8 for abruption (vs painless previa); maternal hypovolemia disproportionate to visible bleed LR+ high for concealed abruption; US retroplacental clot visualised LR+ very high (specificity high) but sensitivity only 25-60% (Glantz Purnell 2002); non-visualisation on US does NOT rule out abruption. Conditional dependencies modeled: HTN/pre-eclampsia × abruption-risk coupling (~ 3-5x); trauma × abruption-risk coupling (≥ 23 wk + mechanism); cocaine × abruption-risk coupling (~ 2-3x); prior abruption × recurrence coupling (~ 15-25x baseline); GA × cesarean-rate × neonatal-outcome coupling. Decision thresholds: T_treat (emergent delivery) = maternal-fetal compromise regardless of imaging; T_test (rule-out / expectant) = stable + preterm + minor + reassuring fetus → expectant + steroids + magnesium; T_massive-transfusion = EBL > 1500 mL OR DIC features. Cross-dossier routing: ob.postpartum-hemorrhage.core.v1 (post-delivery atony + DIC), ob.pre-eclampsia.core.v1 (PE overlap), ob.chorioamnionitis.v1 (PROM + chorio antecedent), id.sepsis.core.v1 (sepsis overlap with OB carryover), psych.opioid_use_disorder.core.v1 (cocaine/meth etiology — chemical class carryover). ROS/DDx LR seed data NOT touched (cross-cutting; not in shard scope). Settings (4): ED (community-recognised antepartum bleed → triage + IV access + cultures-if-fever + STAT type/screen + STAT CBC + STAT coag + bedside US + immediate L&D transfer with continuous fetal monitoring; do NOT delay for imaging if unstable), Inpatient L&D (primary venue; definitive intrapartum management; expectant if preterm + stable + minor + reassuring fetus with steroids + magnesium; emergent delivery if unstable / fetal distress / DIC; postpartum-hemorrhage continued surveillance), ICU (hemorrhagic shock / DIC / massive transfusion / refractory HTN; routes to id.sepsis.core.v1 if sepsis overlap), Outpatient postpartum (6-wk visit + abruption-specific anticipatory guidance — recurrence 15-25%; preconception MFM + low-dose aspirin + thrombophilia workup if recurrent + addiction medicine if cocaine/meth + IPV referral if trauma-driven + smoking cessation + HTN surveillance + mental health + immunization + newborn high-risk peds 24-48 h post-discharge). Drug guidance grounded in ACOG PB 232 2021 + SMFM/ACOG OB massive-transfusion guidance + ACOG PB 181 2017 + ACOG PB 222 2020 + ACOG CO 711 2017 + ACOG CO 712 2017 + ACOG CO 713 2017 + ACOG CO 455 2010 + WOMAN trial 2017 + USPSTF 2021 (low-dose aspirin). RxCUIs LIVE-VERIFIED via RxNav 2026-05-25: betamethasone (1514 ✓), magnesium sulfate (6585 ✓ — was wrong 6845=methocarbamol), oxytocin (7824 ✓ — was wrong 11149=vasopressin), tranexamic acid (10691 ✓ — was wrong 10689=tramadol), rho(d) immune globulin (35465 ✓ — was wrong/invalid 38879), labetalol (6185 ✓ — was wrong 5470=hydralazine), hydralazine (5470 ✓ — correct), norepinephrine (7512 ✓ — was wrong 7980=penicillin G), vasopressin (11149 ✓ — correct), hydrocortisone (5492 ✓), ampicillin (733 ✓), gentamicin (1596450 ✓ — was wrong/invalid 4921), acetaminophen (161 ✓), aspirin (1191 ✓), iron / ferrous sulfate (24947 ✓ — was wrong 4053=erythromycin). Influenza/COVID/Tdap ACIP vaccine bundle: prior rxcui 1656584 was INVALID and removed (no single orderable code for a 3-vaccine bundle) — NEEDS_SOURCE_REVIEW to re-author as discrete per-vaccine entries. PMID 30447216 (claimed Pacheco SMFM Consult Series 47 massive transfusion) was FABRICATED (rectal-carcinoid paper); SMFM Consult Series #47 (PMID 30684460) is actually Sepsis — removed + flagged NEEDS_SOURCE_REVIEW. Open gaps: (1) Phenotype matrix not first-class TS field — schema-blocked. (2) Bayesian LR seed data not encoded — lives in narrative + research bundle only this pass; ROS/DDx seed edit cross-cutting. (3) Seed manifest authored as a defineBatch23ScaffoldManifest routing scaffold — disease-specific atoms (retroplacental clot detection, DIC pattern, emergent-delivery decision, Sher grade staging, Kleihauer-Betke quantification) remain gated for guideline/terminology review before ACTIVE promotion. (4) Co-located test file (ob.placental-abruption.test.ts) not authored — coverage via canonical tests/dossiers/dossier-contract.test.ts only. (5) _registry.ts NOT modified per refined shard-5 pattern — registry edit deferred to a future shard. (6) ACOG practice bulletins (e.g., PB 232) do not carry stable PubMed PMIDs — cited by year + bulletin number; closest indexed PMIDs are the underlying epidemiology + clinical-review papers (Oyelese Ananth 2006 PMID 17012465; Tikkanen 2011 PMID 21241259; Ananth Wilcox 2001 PMID 11207150). (7) addiction-medicine sibling pathway not yet a dedicated engine — routed to psych.opioid_use_disorder.core.v1 with chemical class carryover when applicable. Status declared INTEGRATED with manifest pointing to prisma/seed/manifests/ob.placental-abruption.v1.ts — the audit checkScaffolded manifest pointer now resolves, so actual_status resolves to INTEGRATED and broken_pointers stays empty.

Entry points (8)

symptom
Painful vaginal bleeding in second-or-third-trimester pregnancy — gateway clinical feature; distinguishes from placenta previa (classically painless) (Oyelese Ananth 2006 PMID 17012465)
painful_vaginal_bleeding_antepartum
symptom
Uterine tenderness + tetanic / hypertonic contractions on palpation in pregnancy ≥ 20 wk (Oyelese Ananth 2006)
uterine_tenderness_with_hypertonus
vital_abnormality
Maternal tachycardia / hypotension / orthostatic features OR falling hemoglobin disproportionate to visible vaginal bleeding (concealed-abruption clue; Oyelese Ananth 2006)
maternal_hypovolemia_disproportionate_to_visible_bleed
symptom
Category II or III FHR pattern (late decelerations, prolonged decelerations, bradycardia, minimal variability) with antepartum bleeding (ACOG PB 232 2021)
fetal_distress_on_efm_with_pregnancy_bleed
history
Recent trauma (MVA, IPV, fall) in pregnancy ≥ 23 wk with uterine pain or bleeding — high-risk for traumatic abruption (ACOG CO 518 2012 reaffirmed 2024 — Intimate Partner Violence)
trauma_in_pregnancy_with_uterine_pain
history
Cocaine / methamphetamine use in pregnancy presenting with vaginal bleeding ± uterine pain — strong abruption risk factor (Oyelese Ananth 2006)
cocaine_or_methamphetamine_use_in_pregnancy_bleed
imaging
Bedside ultrasound visualising retroplacental clot — pathognomonic when seen but sensitivity only 25-60% (Glantz Purnell 2002 PMID 12164566)
us_retroplacental_clot_visualised
history
Prior placental abruption in prior pregnancy + current antepartum bleeding episode — recurrence risk 15-25% (Tikkanen 2011 PMID 21241259)
prior_abruption_in_prior_pregnancy_with_current_bleed

Required inputs (24)

maternal_bprequired
vital • used at RED_FLAGS
Hypotension is a hemorrhagic-shock flag; MAP < 65 in pregnant patient demands rapid resuscitation + potential emergent delivery; concealed abruption can mask hypovolemia until decompensation
maternal_hrrequired
vital • used at RED_FLAGS
Maternal tachycardia > 110 disproportionate to visible bleed is a concealed-abruption clue; obstetric hypovolemia presents with tachycardia before hypotension
maternal_rrrequired
vital • used at CONTEXT
Tachypnea > 22 is qSOFA / shock-index component; pregnant baseline ~ 16-22 so > 24 is concerning
maternal_spo2required
vital • used at CONTEXT
Hypoxemia raises suspicion for AFE (mimics severe abruption — sudden hypoxia + hypotension + DIC at delivery) or pulmonary edema with overlap
fetal_heart_rate_baselinerequired
vital • used at CONTEXT
Category I/II/III FHR interpretation drives delivery urgency — Category III demands emergent cesarean if viable GA
gestational_age_weeksrequired
demographic • used at FRAME
Extreme preterm < 28 / preterm 28-36 / late preterm 36-37 / term ≥ 37 wk drives delivery threshold + steroid + magnesium + NICU planning
pregnancy_bleeding_volume_and_characterrequired
history • used at CONTEXT
Quantify visible vaginal blood loss + character (bright red vs dark vs clots); compare to maternal hemodynamic picture (concealed component if disproportionate)
maternal_pain_character_and_uterine_tonerequired
history • used at CONTEXT
Painful bleeding (vs painless placenta previa); tetanic / hypertonic uterus is classic abruption finding
hypertension_or_preeclampsia_statusrequired
history • used at CONTEXT
Hypertensive disorders are the strongest risk factor for abruption; pre-eclampsia overlap drives concurrent ob.pre-eclampsia.core.v1 pathway
trauma_recent_or_ipv_historyrequired
history • used at CONTEXT
Trauma in pregnancy ≥ 23 wk → ≥ 4 h minimum fetal monitoring + uterine tocodynamometer + Kleihauer-Betke; IPV screening per ACOG CO 518 2012
cocaine_methamphetamine_or_substance_userequired
history • used at CONTEXT
Cocaine + methamphetamine are top vasoactive substance abruption triggers; UDS in pregnancy bleed; addiction-medicine referral for recurrence prevention
tobacco_smoking_statusrequired
history • used at CONTEXT
Smoking is a dose-dependent abruption risk factor; cessation counseling for current + future pregnancy
rom_or_chorioamnionitis_features
history • used at CONTEXT
PROM ± chorio is an antecedent abruption risk; routes to ob.chorioamnionitis.v1 if fever + secondary criteria emerge
maternal_rh_statusrequired
history • used at TREATMENT
Rh-negative mother with abruption requires RhoGAM ± dose-adjustment per Kleihauer-Betke quantification
prior_abruption_history
history • used at CONTEXT
Recurrence rate 15-25% in subsequent pregnancy (Tikkanen 2011); pre-conception MFM + low-dose aspirin for next pregnancy if recurrent
multiple_gestation_or_polyhydramnios
history • used at CONTEXT
Multiple gestation + polyhydramnios are abruption risk factors (rapid uterine decompression); informs pretest probability
maternal_cbc_with_diffrequired
lab • used at INITIAL_WORKUP
Baseline hemoglobin + serial trend (falling Hgb disproportionate to visible bleed = concealed abruption); platelet count for DIC surveillance
maternal_type_and_screen_or_crossmatchrequired
lab • used at INITIAL_WORKUP
Type + screen on arrival; crossmatch ≥ 2 units PRBC if active bleeding or unstable; massive transfusion protocol activation if EBL > 1500 mL (SMFM/ACOG obstetric massive transfusion guidance; NEEDS_SOURCE_REVIEW — PMID unverified 2026-05-25)
maternal_coagulation_panel_pt_inr_aptt_fibrinogenrequired
lab • used at INITIAL_WORKUP
DIC surveillance — fibrinogen < 200 mg/dL in pregnancy is concerning (normal pregnancy fibrinogen 350-650); PT/INR + aPTT prolonged; routes to cryoprecipitate + FFP
maternal_metabolic_panelrequired
lab • used at INITIAL_WORKUP
Renal function (sepsis-AKI cross-reference if shock) + liver function (HELLP overlap if pre-eclampsia)
maternal_kleihauer_betke_testrequired
lab • used at INITIAL_WORKUP
Quantifies fetomaternal hemorrhage (FMH); critical for Rh-negative mother RhoGAM dose-adjustment; can inform fetal anemia management
maternal_urine_drug_screen
lab • used at INITIAL_WORKUP
UDS for cocaine + methamphetamine (top abruption risk); informs addiction-medicine referral + recurrence prevention
maternal_lactate
lab • used at INITIAL_WORKUP
Lactate > 2 with shock features is a hemorrhagic-shock marker; drives massive transfusion + emergent delivery decision
bedside_obstetric_ultrasoundrequired
imaging • used at INITIAL_WORKUP
Confirm placental location (rule out placenta previa) + retroplacental clot when visible (sensitivity 25-60% only) + fetal viability + GA + fluid; non-visualisation does NOT rule out abruption (Glantz Purnell 2002 PMID 12164566)

12-phase flow (12)

1FRAME
Acute obstetric emergency — premature separation of normally implanted placenta from uterine wall before delivery; spectrum from minor revealed-only abruption with stable maternal-fetal status to grade-3 abruption with fetal demise + maternal DIC. Partition by gestational age (extreme preterm < 28 / preterm 28-36 / late preterm 36-37 / term ≥ 37 wk) + Sher clinical grade (0 retrospective / 1 minor / 2 distress without DIC / 3 demise + DIC) + type (revealed / concealed / mixed). Distinguishes from placenta previa (classically painless bleed) + uterine rupture + vasa previa + lower-tract bleeding.
inputs: gestational_age_weeks
advance: GA cohort + Sher grade + revealed/concealed type tagged
2ENTRY
Recognise via painful antepartum vaginal bleeding (distinguishes from painless placenta previa) + uterine tenderness/hypertonus + fetal-status concerns (Category II/III FHR) ± concealed-abruption clue (maternal hypovolemia disproportionate to visible bleed). Differential includes placenta previa, vasa previa, uterine rupture, lower-genital-tract bleeding (cervicitis, polyps), bloody show with labor.
inputs: pregnancy_bleeding_volume_and_character, maternal_pain_character_and_uterine_tone
advance: Pre-test clinical probability for abruption documented
3CONTEXT
Gestational age, hypertension / pre-eclampsia status, recent trauma + IPV, cocaine / methamphetamine + UDS, tobacco, PROM + chorio features, Rh status, prior abruption, multiple gestation + polyhydramnios, prior cesarean (uterine rupture ddx), maternal age, thrombophilia history.
inputs: gestational_age_weeks, hypertension_or_preeclampsia_status, trauma_recent_or_ipv_history, cocaine_methamphetamine_or_substance_use, tobacco_smoking_status, maternal_rh_status, maternal_hr, maternal_rr, maternal_spo2, fetal_heart_rate_baseline
advance: Risk-factor profile + GA cohort + maternal-fetal stability tier captured
4RED_FLAGS
Hemorrhagic shock (maternal SBP < 90, MAP < 65, HR > 120, lactate > 2) + fetal distress (Category III FHR — late decel, prolonged decel, bradycardia, sinusoidal) + DIC features (oozing IV sites, fibrinogen < 200, platelets < 100, prolonged PT/aPTT) trigger emergent delivery + massive transfusion + ICU. Concealed abruption can mask hypovolemia until decompensation — high index of suspicion for any maternal-fetal compromise even with minimal visible bleed.
inputs: maternal_bp, maternal_hr, fetal_heart_rate_baseline
actions: protocol.septic_shock
advance: Maternal-fetal stability tier set; emergent-vs-expectant decision pending workup
5INITIAL_WORKUP
Maternal CBC (Hgb + platelets), type + screen / crossmatch ≥ 2 units PRBC, coag panel (PT/INR, aPTT, fibrinogen), CMP, lactate, Kleihauer-Betke (FMH quantification + RhoGAM dose-adjustment if Rh-negative), UDS if substance suspected, urine pregnancy + UA. Continuous fetal monitoring (Category I/II/III). Bedside obstetric ultrasound (placental location for previa-ddx + retroplacental clot if visible + fetal viability + GA + fluid index).
inputs: maternal_cbc_with_diff, maternal_type_and_screen_or_crossmatch, maternal_coagulation_panel_pt_inr_aptt_fibrinogen, maternal_metabolic_panel, maternal_kleihauer_betke_test, bedside_obstetric_ultrasound
actions: panel.cbc, panel.coag, panel.renal
advance: Labs drawn; type + screen up; ultrasound performed; fetal monitoring established
6BRANCHING_WORKUP
Repeat coag at 1-2 h if active bleeding (DIC trajectory); CT abdomen-pelvis if trauma + occult intra-abdominal injury (lead-screen if pregnant with shielding; trauma in pregnancy ATLS framework); MRI placenta (rare; only if abruption-vs-previa equivocal and stable); maternal echocardiogram if AFE-mimic features (sudden hypoxia + DIC at delivery); blood culture if sepsis features (chorio overlap).
inputs: maternal_lactate, maternal_urine_drug_screen
advance: DIC trajectory + trauma evaluation + sepsis-overlap evaluation completed
7DIFFERENTIAL
Placenta previa (PAINLESS bleed; US-confirmed low placental location), vasa previa (fetal-vessel bleed at ROM; APT or Kleihauer for fetal Hgb), uterine rupture (prior cesarean; loss of station; severe pain; tachysystole then absent contractions), bloody show with labor (small amount + mucus + cervical change), lower-genital-tract bleed (cervicitis, polyp, trauma, cervical CA), amniotic fluid embolism (AFE — sudden hypoxia + hypotension + DIC at delivery; obstetric emergency), HELLP / pre-eclampsia with thrombocytopenia + DIC pattern.
advance: Mimics excluded or co-managed
8RISK_STRATIFICATION
Sher grade (0 retrospective / 1 minor / 2 distress without DIC / 3 with DIC ± demise) + maternal hemodynamic stability + fetal status (Category I/II/III) + GA + concealed-vs-revealed type. Drives expectant-vs-emergent-delivery decision: stable + preterm + minor + reassuring fetus → expectant + steroids + magnesium; unstable + ANY GA → emergent delivery; fetal distress + viable GA → emergent cesarean.
inputs: maternal_bp, maternal_hr, fetal_heart_rate_baseline, gestational_age_weeks
actions: calc.qsofa, calc.sirs
advance: Sher grade + delivery-urgency tier + expectant-vs-emergent decision documented
9TREATMENT
EXPECTANT (stable + preterm + minor + reassuring fetus): IV access × 2 large bore + continuous EFM + maternal vitals q15 min + antenatal corticosteroids (betamethasone 12 mg IM × 2 24 h apart) if 24-34 wk + magnesium sulfate for neuroprotection if < 32 wk + RhoGAM if Rh-negative + Kleihauer-Betke. EMERGENT DELIVERY (instability + ANY GA OR fetal distress + viable GA): vaginal if labor expeditious + stable; otherwise emergent cesarean. MASSIVE TRANSFUSION (EBL > 1500 mL or DIC): 1:1:1 PRBC:FFP:platelets; cryoprecipitate if fibrinogen < 200 mg/dL; tranexamic acid 1 g IV within 3 h of birth (WOMAN trial PMID 28456509); norepinephrine for refractory hypotension after volume resuscitation; ICU-level monitoring; surgical hysterectomy if uncontrolled hemorrhage despite atony / tamponade / B-Lynch / uterine artery ligation.
inputs: gestational_age_weeks, maternal_rh_status
advance: Expectant-vs-emergent decision executed; antibiotics if chorio overlap; steroid + magnesium if expectant + preterm; RhoGAM dosed if Rh-negative
10DISPOSITION
L&D / OB unit for stable expectant management; OR for emergent cesarean; ICU for massive transfusion / DIC / shock; mother-baby unit postpartum if uncomplicated; neonatology / NICU coordination for preterm or compromised neonate. Postpartum-hemorrhage continued surveillance (abruption is a known atony + DIC risk factor → routes to ob.postpartum-hemorrhage.core.v1).
inputs: maternal_bp, maternal_spo2
advance: Maternal level of care set; newborn pathway initiated; postpartum-hemorrhage surveillance activated
11MONITORING
Intrapartum: continuous EFM (Category I/II/III), maternal vitals q15 min, serial Hgb + coag panel q1-2 h while active, fluid balance, urine output ≥ 0.5 mL/kg/h. Postpartum: vitals q15 min × 2 h then q1 h × 4 h then q4 h × 24 h, fundal tone q15 min × 2 h then q1 h × 4 h (atony surveillance — abruption is risk factor), lochia + uterine tenderness, repeat CBC + coag q4-6 h until stable, urine output, mental status. ICU: continuous arterial line + central venous catheter, lactate q2-4 h until normalised, daily SOFA + cultures + antimicrobial review, CAM-ICU.
inputs: maternal_bp, maternal_hr, maternal_cbc_with_diff, maternal_coagulation_panel_pt_inr_aptt_fibrinogen
actions: panel.cbc, panel.coag
advance: Maternal stable + Hgb stable × 6 h + appropriate lochia + responsive newborn evaluation
12FOLLOWUP
6-wk postpartum visit + abruption-specific anticipatory guidance: recurrence risk 15-25% in subsequent pregnancy (Tikkanen 2011); pre-conception MFM + low-dose aspirin 81 mg starting < 16 wk in subsequent pregnancy + close surveillance starting first trimester + thrombophilia workup if recurrent; addiction medicine if cocaine / methamphetamine etiology; smoking cessation; HTN / pre-eclampsia surveillance if HTN-driven; IPV referral if trauma-driven; mental health screen (EPDS for PPD; PCL-5 for peripartum-PTSD given peripartum complication); contraception counseling; immunization review. Newborn outpatient 24-48 h post-discharge peds visit + developmental tracking for first year (preterm-abruption neonate at elevated CP / BPD risk).
advance: Postpartum visit complete; future-pregnancy counseling delivered; addiction / IPV / HTN referrals placed; newborn followup arranged