| Definition | • Premature placental detachment from the uterus before fetal delivery due to bleeding at the uteroplacental interface→retroplacental bleeding |
|---|---|
| Risk factors | • Hypertension, preeclampsia |
| • Abdominal trauma | |
| • Prior abruptio placentae (most predictive) | |
| • Cocaine & tobacco use | |
| • Uterine overdistension (twin gestation, severe polyhydramnios) | |
| • Advanced maternal age | |
| • Multiparity | |
| • Low BMI | |
| Clinical presentation | • Sudden-onset vaginal bleeding (up to 20% have minimal or no bleeding because blood is concealed within the intrauterine cavity) |
| • Abdominal or back pain due to accumulation of blood → increase pressure | |
| • High-frequency, low-intensity contractions due to uterine irritability from increase pressure and volume | |
| • Rigid, tender uterus, if concealed→ distended uterus | |
| • Abnormal fetal heart rate tracing (eg, bradycardia, minimal variability) | |
| Diagnosis | • Clinical |
| • Ultrasound may show Retroplacental hematoma | |
| Complications | • Fetal hypoxia, preterm birth, mortality |
| • Maternal hemorrhage & hypovolemic shock, DIC (due to tissue factor released in response to decidual bleeding) |
Some cases of abruptio placentae are self-limited and clinically insignificant; however, as more of the placenta detaches, there is greater risk for maternal and fetal complications.
concealed abruptions typically have severe focal pain at the location of the placenta (such as this patient with mid-epigastric pain, which suggests a fundal placenta) that then progresses to diffuse uterine tenderness.
As blood accumulates between the placenta and uterine wall, the intrauterine pressure increases (leading to a distended, tender uterus) and induces uterine irritability (triggering high-frequency contractions).
May happen after ROM so don’t be fooled with vasa previa and placenta previa as those conditions are painless
<aside> 💡 Due to the volume of blood supplied to the uterus, abruptio placentae can cause hypovolemic shock from hemorrhage (ie, hemorrhagic shock).
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<aside> 💡 up to 20% have a concealed abruption, in which there is no visible bleeding.
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JUH mentions IVF as risk factor for placental abruption
Placental abruption is a clinical diagnosis. Furthermore, TVUS has very low sensitivity in the detection of abruptio placentae.
<aside> 💡 Uterine rupture typically have increasingly irregular contractions that decrease in intensity because ruptured myometrial fibers cannot contract in unison. vs the regular contractions seen in abruption
Uterine rupture commonly causes abdominal pain, vaginal bleeding, and fetal heart rate abnormalities. However, patients typically have diminishing contractions and fetal parts palpable through the maternal abdominal wall.
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