Summary
Definition
Separación prematura de una placenta normoinserta de la pared uterina que se produce antes del parto del feto.[1] El desprendimiento puede ser manifiesto cuando hay sangrado vaginal, u oculto, si el sangrado sucede detrás de la placenta y no existe evidencia de sangrado vaginal.[1] El desprendimiento puede ser parcial y afectar solo parte de la placenta, o puede ser total y afectar toda la placenta.
[Figure caption and citation for the preceding image starts]: Tipos de desprendimiento prematuro de placenta. (A) Desprendimiento prematuro de placenta manifiesto, donde la sangre pasa entre las membranas y sale por la vagina y el cuello uterino. (B) Desprendimiento prematuro de placenta oculto, donde la sangre se acumula detrás de la placenta y no existe evidencia de sangrado vaginalOyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. 2006;108:1005-1016. Usado con autorización [Citation ends].
History and exam
Key diagnostic factors
- sangrado vaginal
- dolor abdominal
- contracciones uterinas
- sensibilidad uterina
Other diagnostic factors
- dolor en la zona lumbar
- muerte fetal
Risk factors
- hipertensión crónica
- preeclampsia
- tabaquismo
- consumo de cocaína
- traumatismo
- parto previo por cesárea
- ruptura prematura de las membranas pretérmino
- multiparidad
- edad materna avanzada
- polihidramnios
- corioamnionitis
- malformaciones uterinas
- desprendimiento prematuro de placenta previo
- embarazo múltiple
- oligohidramnios
- leiomiomas uterinos
- trombofilias
Diagnostic tests
1st tests to order
- monitorización fetal
- Hb y hematocrito
- estudios de coagulación
- prueba de Kleihauer-Betke (K-B)
- ultrasonido
Tests to consider
- patología placentaria
Treatment algorithm
todos los pacientes
Feto vivo: >34 semanas
Feto vivo: ≤34 semanas
muerte fetal
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
Disclosures
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
Disclosures
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.
References
Key articles
American College of Radiology. ACR appropriateness criteria: second and third trimester bleeding. 2020 [internet publication].Full text
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Trabajo de parto prematuro
- Placenta previa
- Corioamnionitis
More DifferentialsGuidelines
- Intrapartum care
- ACR appropriateness criteria: second and third trimester vaginal bleeding
More GuidelinesPatient information
Cistitis
Presión arterial alta: preguntas para formularle al médico
More Patient information
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