Placental abruption (aka abruptio placentae) is a complication of pregnancy, where the placental lining abnormally separates from the uterus, >20 weeks gestation, and prior to birth.

Patient information

What is placental abruption? It sounds like the placenta is about to blow up ?
Sort of. The word abruption actually means breakaway (like the Kelly Clarkson song ), like if you abruptly leave a group, you're suddenly breaking away. The placenta is a flat organ that attaches bub to the womb's wall to get nutrients. So it's when that suddenly breaks off.

Why does it need to be within that timeframe, after 20 weeks gestation, and before birth?
Because before 20 weeks is previable, so we just call it a miscarriage. It has to be before birth, because after birth, the placenta is SUPPOSED to detach, and in fact come out hopefully, within 30 minutes of delivery .

• Asymptomatic, in early stages
• Sudden onset abdominal pain, most commonly
• Vaginal bleeding
• Contractions that don't stop, so rapidly that they seem continuous
• Pain in the uterus
• Uterus may be disproportionately enlarged
• Pallor
• Non-reassuring fetal status (i.e. decrased FM, worrisome FHR)

• Grade 0, asymptomatic and only Dx through postpartum examination of the placenta
• Grade 1, where the mother may have vaginal bleeding w/ mild uterine tenderness, but there is no disterss of mother/fetus
• Grade 2, where the mother is symptomatic but not in shock. Some evidence of fetal distress can be found w/ FHR monitoring
• Grade 3, where thre is severe bleeding (which may be occult), leading to maternal shock and fetal death. There may be maternal DIC

• Trauma, HTN or coagulopathy, causes forcible detachment of the anchoring placental villi, from the expanding lower uterine segment. This causes bleeding in the uterine lining
• This can push the placenta away from the uterus, causing further bleeding

• Pre-eclampsia
• Chronic HTN
• Maternal smoking → 90% increased risk
• Maternal trauma, including MVA, assaults, falls
• Short umbilical cord
• PROM (>24 hours)
• Thrombophilia
• Uterine fibroid
• Multiparity, multiple pregnancy
• Maternal age<20yo, >35yo
• Hx of placental abruption in previous pregnancy
• Hx of previous C-section
• Some infections
• Cocaine intoxication or abuse during pregnancy

• Dx by exclusion
• CTG → fetal HR is associated w/ severity, can indicate fetal distress
• Palpation, of location of fundus → rising fundus can indicate bleeding
• U/S → rule out placenta previa, but doesn't Dx abruption
• MRI can locate placental abruption

Tx depends on how serious the abruption is, and how far along the woman is in her pregnancy.

• Prevention, including:
  • Avoid tobacco, alcohol, cocaine during pregnancy
  • Stay away from activities which have a high risk of physical trauma
  • Careful monitoring of women who have HTN or previous placental abruption
  • Maintianing a good diet, icnluding taking folic acid
  • Regular sleep patterns
  • Correction of pregnancy-induced HTN
  • Be aware of Sx of placental abruption (e.g. vaginal bleeding), and get in contact wiht hospital w/o delay if they occur
• ABC's:
  • Blood volume replacement, to maintain BP
  • Blood plasma replacement, to maintain fibrinogen levels
• If <36 weeks gestation, if possible, monitor in hospital
• Immediate delivery, if the fetus is mature, or if the fetus/mother is in distress. Vaginal birth is usually preferred over C section unless there is fetal distress. C section is contraindicated in DIC. Pt should be monitored 7 days post-delivery for PPH
• Hysterectomy, if there is excessive bleeding from the uterus
• Anti-D, if the mother is Rh negative

• Effects on mother depends on severity of abruption
• Effects on fetus depend on both its severity and gestational age at which it occured

• Most common pathological cause of late pregnancy bleeding
• Occurs in 0.5% of deliveries
• Significant contributor to maternal mortality worldwide
• Early and skilled medical intervention is needed to ensure a good outcome, and is not available in many parts of the world

• Placental abruption has effects on both mother and fetus
• The effects on the mother depend primarily on the severity of the abruption, while the effects on the fetus depend on both its severity and gestational age at which it occurs
• The HR of the fetus can be associated with the severity