Abruptio placentae is premature separation of a normally implanted placenta from the uterus, usually after 20 weeks gestation. It can be an obstetric emergency. Placental abruption is thought to be the end result of chronic placental insufficiency and/or placental vascular disease. There are numerous risk factors, including previous placental abruption, tobacco use, cocaine use, abdominal trauma, polyhydramnios, hypertensive disorders, chorioamnionitis, and older maternal age.
Manifestations may include vaginal bleeding, uterine pain and tenderness, hemorrhagic shock, and disseminated intravascular coagulation. Diagnosis is clinical and sometimes by ultrasonography. Treatment is modified activity (eg, a woman's staying off her feet for most of the day) for mild symptoms and prompt delivery for maternal or fetal instability or a near-term pregnancy.
If the maternal-fetal dyad cannot be stabilized, immediate delivery (likely via cesarean delivery if vaginal delivery is not imminent) is indicated. If there is no evidence of hemodynamic instability in the mother or distress in the fetus, the appropriate management depends on gestational age. If the diagnosis of abruption is highly suspected and the patient is at term (37 weeks or beyond), the patient should be admitted to the labor floor and labor induced or augmented. If the patient is preterm, management depends on the severity of the presentation. Patients with a small amount of bleeding which resolves and who have reassuring fetal evaluations may be managed expectantly until the pregnancy reaches term.
Please see Vaginal Bleeding During Late Pregnancy in The Manuals for more details.
References
Ananth CV. Placental Abruption among Singleton and Twin Births in the United States: Risk Factor Profiles. Am J Epidemiol. April 2001; 153(8): 771-778.
Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period. Am J Obstet Gynecol. 2018 Jan; 218(1): B2-B8.
Kramer MS, Usher RH, Pollack R, et al. Etiologic determinants of abruptio placentae. Obstet Gynecol. 1997; 89: 221.
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