Placental Abruption

Dec 21, 2011
Michelle Parker

Pregnancy - Mahalie Stackpole, 2004

Placental abruption is a condition that can arise during pregnancy due to an abnormality with the placenta.

Placental abruption refers to the premature separation of a normally implanted placenta from the uterus.

Clinical features

Placental abruption is associated with vaginal or occult (hidden) uterine bleeding, abdominal or back pain, uterine contractions and uterine tenderness and irritability. Bleeding can be ‘revealed’ or less commonly and more dangerously ‘concealed’, where blood accrues behind the placenta and there is no apparent external bleeding. Different cases of placental abruption can present differently, and some cases may not involve haemorrhage at all.

It poses risks related to the mortality and morbidity of the fetus, depending on the severity of the abruption and gestational age when the abruption occurs. This is largely the result of preterm delivery, and long-term handicap due to oxygen and nutritional deprivation from premature separation of the placenta. Maternal risks depend on the severity of the abrupton include disseminated intravascular coagulopathy, renal failure, obstetric haemorrhage, need for hysterectomy and maternal death.

Risk factors

A variety of risk factors have been linked with placental abruption, which include increasing parity, advanced maternal age, cigarette smoking, trauma, maternal hypertension, multiple gestation and previous abruption.

Diagnosis

Placental abruption is usually clinically diagnosed by vaginal bleeding in the third trimester. Ultrasonogaphy may be of limited value.

Management

Management of placental abruption usually depends on the severity of the abruption, the gestational age at the time of presentation and the status of both mother and fetus.

A case of placental abruption that is not of a severe kind is usually dealt with by expectant management to prolong the pregnancy. Management usually involves close monitoring and rapid delivery if the need arises.

For women with placental abruption at or near term, delivery should take place, preferably vaginal delivery but caesarean delivery can be performed if necessary.

References:

Cunningham, F.G., Leveno, K.J., Bloom, S.L., Hauth, J.C., Rouse, D.J., and Spong, C.Y. (2010). Williams obstretrics (23rd ed.). USA: McGraw-Hill.
Francois, K.E. and Foley, M.R. (2007). Antepartum and Postpartum Hemorrhage. In Gabbe, S.G., Niebyl, J.R. and Simpson, J.L. Obstretics: Normal and problem pregnancies (5th ed.). Philadelphia: Churchill Livingstone.
Oyelese, Y., & Smulian, J. C. (2006). Placenta previa, placenta accreta, and vasa previa. Obstetrics & Gynecology, 107(4), 927-941.
Oyelese, Y., & Ananth, C. V. (2006). Placental abruption. Obstetrics & Gynecology, 108(4), 1005-1016.
Scearce, J. and Uzelac, P.S. (2007). In DeCherney, A.H. and Nathan, L. Current diagnosis and treatment: Obstretrics and gynecology (10th ed.). USA: McGraw-Hill.
Schoenwolf, G.C., Bleyl, S.B., Brauer, P.R. and Francis-West, P.H. (2009). Larsen's human embryology (4th ed.). New York; Edinburgh: Churchill Livingstone.