Placental Abruption
Basics
Description
Description
- Hemorrhage at the decidual–placental interface leading to complete or partial separation of the placenta before delivery of the fetus
- Incidence/prevalence:
- ∼1% of all pregnancies
- 30% of bleeding episodes in the second half of pregnancy
- Associated with a 20-fold increase in perinatal death (from 0.6–12% in the case of placental abruption)
- Classification:
- By presence or absence of vaginal bleeding:
- Revealed (vaginal bleeding present, 65–80% of cases)
- Concealed (vaginal bleeding absent, 20–35% of cases)
- By amount of placental separation:
- Partial (only part of placenta detached, 93% of cases)
- Total or complete (entire placenta detached, 7% of cases)
- By severity:
- Grade 0 – asymptomatic
- Grade 1 – no signs of maternal or fetal distress
- Grade 2 – no signs of maternal distress/shock but fetal distress is present
- Grade 3 – maternal shock, fetal distress, or death
- By presence or absence of vaginal bleeding:
- Synonym(s): Abruptio placentae, placenta abruption, ablation placentae, accidental hemorrhage (in the UK)
Etiology
Etiology
- Hemorrhage of a maternal artery or vein causing bleeding at the decidual–placental interface leading to premature placental separation
- Inciting event may be unclear
- The majority of abruptions are due to chronic processes:
- Inflammatory changes in the placenta
- Manifestation of ischemic placental disease
- Defective trophoblastic implantation
- Acute abruption can occur due to:
- Trauma
- Rapid uterine decompression
- Placenta implantation over a uterine anomaly or fibroid
- Multiple known risk factors:
- Previous abruption (10–20% recurrence risk)
- Maternal hypertension (>140/90) and pre-eclampsia
- Increased parity and maternal age
- Multiple gestation
- Fibroids or other uterine/placental abnormalities
- Tobacco use
- Cocaine abuse
- Trauma
- Premature rupture of membranes, particularly if associated with chorioamnionitis or oligohydramnios
- Rapid uterine decompression:
- Polyhydramnios with membrane rupture
- Rapid delivery of first twin
- Elevated second trimester maternal serum α-fetoprotein
- Thrombophilias
- First or second trimester vaginal bleeding
- Maternal race:
- More common among African American and Caucasian women
- Incidence increasing more rapidly among African American women
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Citation
Schaider, Jeffrey J., et al., editors. "Placental Abruption." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307663/4/Placental_Abruption.
Placental Abruption. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307663/4/Placental_Abruption. Accessed March 29, 2024.
Placental Abruption. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307663/4/Placental_Abruption
Placental Abruption [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2024 March 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307663/4/Placental_Abruption.
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