Placental Abruption

Placental Abruption is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Hemorrhage at the decidual–placental interface leading to complete or partial separation of the normallyimplanted placenta before delivery of the fetus
  • Incidence/prevalence:
    • ∼1% of all pregnancies
    • 30% of bleeding episodes in the 2nd half of pregnancy
    • 15% of all fetal deaths
    • Neonatal death in 10–30% of cases
    • 6% of all maternal mortality
  • Synonym(s): Abruptio placentae, accidental hemorrhage (in UK)

Etiology

  • Primary cause unknown
  • Vascular injury with dissection of blood into the decidua basalis or mechanical shearing between the placenta and uterus leading to bleeding and clot formation
  • More severe cases lead to:
    • Development of disseminated intravascular coagulation (DIC)
    • Maternal–fetal compromise
  • Research suggests that the majority of abruptions are due to chronic processes:
    • Inflammatory changes in the placenta
    • Manifestation of ischemic placental disease
  • 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 preeclampsia
    • 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 1st twin
    • Elevated 2nd trimester maternal serum α-fetoprotein
    • Thrombophilias
    • Maternal race:
      • More common among African American and Caucasian women
      • Incidence increasing more rapidly among African American women

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Citation

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TY - ELEC T1 - Placental Abruption ID - 307663 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307663/all/Placental_Abruption ER -