Placental abruption
Summary
Definition
The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus.[1] Abruption may be revealed, if blood escapes through the vagina, or concealed, if the bleeding occurs behind the placenta, with no evidence of bleeding from the vagina.[1] 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].
History and exam
Key diagnostic factors
- vaginal bleeding
- abdominal pain
- uterine contractions
- uterine tenderness
Other diagnostic factors
- lower back pain
- fetal death
Risk factors
- chronic hypertension
- preeclampsia
- smoking
- cocaine use
- trauma
- prior cesarean delivery
- preterm premature rupture of the membranes
- multiparity
- advanced maternal age
- polyhydramnios
- chorioamnionitis
- uterine malformations
- prior placental abruption
- multifetal gestations
- oligohydramnios
- uterine leiomyomas
- thrombophilias
Diagnostic investigations
1st investigations to order
- fetal monitoring
- Hb and hematocrit
- coagulation studies
- Kleihauer-Betke (K-B) test
- ultrasound
Investigations to consider
- placental pathology
Treatment algorithm
all patients
live fetus: >34 weeks
live fetus: ≤34 weeks
fetal demise
Contributors
Authors
Yinka Oyelese, MD, FACOG
Director, Obstetric Imaging
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston
MA
Disclosures
YO is an author of a number of references cited in this topic.
Anthony M. Vintzileos, MD, FACOG
Chairman
Department of Obstetrics and Gynecology
Winthrop University Hospital
Mineola
Professor
Obstetrics, Gynecology, and Reproductive Medicine
Stony Brook School of Medicine
Stony Brook
NY
Disclosures
AMV declares that he has no competing interests.
Peer reviewers
Christopher Glantz, MD, MPH
Professor of Obstetrics and Gynecology
University of Rochester School of Medicine
Rochester
New York
NY
利益声明
CG declares that he has no competing interests.
Austin Ugwumadu, PhD, FRCOG
Consultant/Senior Lecturer in Obstetrics and Gynaecology
St George's Hospital
London
UK
利益声明
AU declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
American College of Radiology. ACR appropriateness criteria: second and third trimester bleeding. 2020 [internet publication].全文
Society for Maternal-Fetal Medicine (SMFM), 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):B2-8.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Preterm labor
- Placenta previa
- Chorioamnionitis
更多 鉴别诊断指南
- ACR appropriateness criteria: second and third trimester vaginal bleeding
- Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period
更多 指南患者教育信息
Appendicitis
Cystitis
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明