From the Research
Placenta abruption is a serious obstetric emergency where the placenta partially or completely separates from the uterine wall before delivery, requiring immediate medical attention to prevent maternal and fetal morbidity and mortality. This condition occurs in approximately 0.4% to 1.2% of all pregnancies, with nearly half of cases occurring at term gestations 1. The clinical manifestations of placental abruption typically include vaginal bleeding, abdominal pain, and uterine contractions, with a wide variety of abnormal fetal heart rate patterns 1.
Pathophysiology and Epidemiology
The pathophysiology of placental abruption remains incompletely understood but is thought to involve impaired placentation, placental insufficiency, intrauterine hypoxia, and uteroplacental underperfusion 2. Risk factors for abruption include prior abruption, smoking, trauma, cocaine use, multifetal gestation, hypertension, preeclampsia, thrombophilias, advanced maternal age, preterm premature rupture of the membranes, intrauterine infections, and hydramnios 3.
Diagnosis and Management
The diagnosis of placental abruption is clinical, with ultrasonography and the Kleihauer-Betke test having limited value 3. Management should be individualized based on the severity of the abruption, gestational age, and maternal and fetal status 3, 1. In cases where fetal demise has occurred, vaginal delivery is preferable, while disseminated intravascular coagulopathy should be managed aggressively 3. For abruptions occurring at or near term with reassuring maternal and fetal status, conservative management with the goal of vaginal delivery may be reasonable, but prompt delivery by cesarean is often indicated in the presence of fetal or maternal compromise 3, 1.
Key Considerations
- Prompt recognition and management are critical to improving maternal and fetal outcomes in cases of placental abruption.
- The severity of placental abruption can vary, and management strategies should be tailored to the individual case.
- Close monitoring for disseminated intravascular coagulation (DIC) is crucial, and blood products may be required in cases of significant bleeding or coagulopathy 3, 1.
- After delivery, vigilant observation for postpartum hemorrhage is essential to prevent further complications.
Given the most recent and highest quality evidence, the management of placental abruption should prioritize minimizing morbidity, mortality, and optimizing quality of life for both the mother and the fetus, with a focus on prompt and individualized care based on the severity of the condition and the gestational age at the time of occurrence 1.