Placental abruption is the separation of the normally located placenta before delivery of the fetus. It 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. 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. Abruption may be partial, affecting only part of the placenta, or total, involving the entire placenta.
History and exam
Key diagnostic factors
- vaginal bleeding
- abdominal pain
- uterine contractions
- uterine tenderness
Other diagnostic factors
- lower back pain
- fetal death
- chronic hypertension
- cocaine use
- prior cesarean delivery
- preterm premature rupture of the membranes
- advanced maternal age
- uterine malformations
- prior placental abruption
- multifetal gestations
- uterine leiomyomas
1st investigations to order
- fetal monitoring
- Hb and Hct
- coagulation studies
- Kleihauer-Betke (K-B) test
Investigations to consider
- placental pathology
live fetus: >34 weeks
live fetus: ≤34 weeks
Yinka Oyelese, MD, FACOG
Director, Obstetric Imaging
Beth Israel Deaconess Medical Center
Harvard Medical School
YO is an author of a number of references cited in this topic.
Anthony M. Vintzileos, MD, FACOG
Department of Obstetrics and Gynecology
Winthrop University Hospital
Obstetrics, Gynecology, and Reproductive Medicine
Stony Brook School of Medicine
AMV declares that he has no competing interests.
Christopher Glantz, MD, MPH
Professor of Obstetrics and Gynecology
University of Rochester School of Medicine
CG declares that he has no competing interests.
Austin Ugwumadu, PhD, FRCOG
Consultant/Senior Lecturer in Obstetrics and Gynaecology
St George's Hospital
AU declares that he has no competing interests.
- Preterm labor
- Placenta previa
- ACR appropriateness criteria: second and third trimester vaginal bleeding
- Inherited thrombophilias in pregnancy
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