Placental abruption

Placental abruption
Other namesAbruptio placentae
Drawing of internal and external bleeding from placental abruption
SpecialtyObstetrics
SymptomsVaginal bleeding, low abdominal pain, dangerously low blood pressure[1]
ComplicationsMother: disseminated intravascular coagulopathy, kidney failure[2]
Baby: low birthweight, preterm delivery, stillbirth[2]
Usual onset24 to 26 weeks of pregnancy[2]
CausesUnclear[2]
Risk factorsSmoking, preeclampsia, prior abruption[2]
Diagnostic methodBased on symptoms, ultrasound[1]
Differential diagnosisPlacenta previa, bloody show, chorioamnionitis[3]
TreatmentBed rest, delivery[1]
MedicationCorticosteroids[1]
Frequency~0.7% of pregnancies[2]

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth.[2] It occurs most commonly around 25 weeks of pregnancy.[2] Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.[1] Complications for the mother can include disseminated intravascular coagulopathy and kidney failure.[2] Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.[2][3]

The cause of placental abruption is not entirely clear.[2] Risk factors include smoking, pre-eclampsia, prior abruption (the most important and predictive risk factor), trauma during pregnancy, cocaine use, and previous cesarean section.[2][1] Diagnosis is based on symptoms and supported by ultrasound.[1] It is classified as a complication of pregnancy.[1]

For small abruption, bed rest may be recommended, while for more significant abruptions or those that occur near term, delivery may be recommended.[1][4] If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended.[1] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs.[1] Treatment may require blood transfusion or emergency hysterectomy.[2]

Placental abruption occurs in about 1 in 200 pregnancies.[5] Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy.[6] Placental abruption is the reason for about 15% of infant deaths around the time of birth.[2] The condition was described at least as early as 1664.[7]

  1. ^ a b c d e f g h i j k "Abruptio Placentae - Gynecology and Obstetrics". Merck Manuals Professional Edition. October 2017. Retrieved 9 December 2017.
  2. ^ a b c d e f g h i j k l m n Tikkanen, M (February 2011). "Placental abruption: epidemiology, risk factors and consequences". Acta Obstetricia et Gynecologica Scandinavica. 90 (2): 140–9. doi:10.1111/j.1600-0412.2010.01030.x. PMID 21241259. S2CID 10871832.
  3. ^ a b Saxena, Richa (2014). Bedside Obstetrics & Gynecology. JP Medical Ltd. pp. 205–209. ISBN 9789351521037.
  4. ^ Gibbs, Ronald S. (2008). Danforth's Obstetrics and Gynecology. Lippincott Williams & Wilkins. p. 385. ISBN 9780781769372.
  5. ^ Williams obstetrics (24th ed.). New York: McGraw-Hill education. 2014. ISBN 978-0-07-179893-8.
  6. ^ Hofmeyr, GJ; Qureshi, Z (October 2016). "Preventing deaths due to haemorrhage". Best Practice & Research. Clinical Obstetrics & Gynaecology. 36: 68–82. doi:10.1016/j.bpobgyn.2016.05.004. PMID 27450867.
  7. ^ The Journal of the Indiana State Medical Association. The Association. 1956. p. 1564.
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