Placental abruption

Separation of the normally located placenta before delivery of the fetus. May be concealed or overt.

Frequently presents as vaginal bleeding associated with abdominal pain and contractions in the second half of pregnancy.

Associated with increased perinatal mortality and morbidity. Also a cause of significant maternal morbidity.

Risk factors include smoking, trauma, hypertensive disorders, and cocaine use.

Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable.

Management and outcome depend on the gestational age, the degree of separation, and the maternal and fetal status.

The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus.[1]Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005-1016. http://www.ncbi.nlm.nih.gov/pubmed/17012465?tool=bestpractice.com Abruption may be revealed, when blood escapes through the vagina, or concealed, when the bleeding occurs behind the placenta, with no evidence of bleeding from the vagina.[1]Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005-1016. http://www.ncbi.nlm.nih.gov/pubmed/17012465?tool=bestpractice.com Abruption may be partial, affecting only part of the placenta, or total, involving the entire placenta.

[Figure caption and citation for the preceding image starts]: Types of placental abruption. (A) Revealed placental abruption, where blood tracks between the membranes, and escapes through the vagina and cervix. (B) Concealed placental abruption where blood collects behind the placenta, with no evidence of vaginal bleedingOyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005-1016. Used with permission [Citation ends].