From the Guidelines
Abruptio placenta, or placental abruption, is a serious pregnancy complication where the placenta partially or completely separates from the inner wall of the uterus before delivery, affecting approximately 1% of pregnancies 1. This premature separation can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother.
Key Characteristics
- It typically occurs suddenly in the third trimester, though it can happen anytime after 20 weeks of pregnancy.
- Symptoms include:
- Vaginal bleeding
- Abdominal pain
- Back pain
- Uterine tenderness
- Frequent contractions
Severity and Risk Factors
- The severity ranges from mild to severe, with severe cases potentially leading to fetal distress or death and maternal hemorrhage.
- Risk factors include:
- Previous abruption
- Hypertension
- Preeclampsia
- Trauma
- Smoking
- Cocaine use
- Advanced maternal age
- Multiple pregnancies
Management and Prevention
- Management depends on severity, gestational age, and maternal/fetal status, ranging from close monitoring to emergency cesarean delivery.
- There is no specific prevention, but controlling risk factors like hypertension and avoiding substance use can help reduce risk.
- Any pregnant woman experiencing vaginal bleeding or severe abdominal pain should seek immediate medical attention as prompt treatment is essential for both maternal and fetal outcomes. It's also important to note that women with a history of placental abruption are at increased risk of future cardiovascular disease 1.
From the Research
Definition of Abruptio Placenta
- Abruptio placenta, also known as placental abruption, is a complete or partial separation of the placenta from the uterine decidua 2, 3, 4.
- This condition occurs when the placenta prematurely separates from the uterus before the delivery of the fetus, which can lead to vaginal bleeding, abdominal pain, uterine contractions, and abnormalities in the fetal heart rate tracing 2, 3, 4.
Clinical Manifestations
- The clinical manifestations of placental abruption typically include vaginal bleeding and abdominal pain, with a wide variety of abnormal fetal heart rate patterns 2, 3, 4.
- The condition can range from asymptomatic to severe, with massive abruption leading to fetal death and severe maternal morbidity 3.
Epidemiology
- Placental abruption occurs in approximately 0.4% to 1.0% of all pregnancies, with nearly half of cases occurring at term gestations 2, 4, 5.
- The prevalence of placental abruption varies by region, with lower rates reported in Nordic countries compared to the USA 5.
Pathophysiology
- The etiology of placental abruption is not fully understood but is thought to involve impaired placentation, placental insufficiency, intrauterine hypoxia, and uteroplacental underperfusion 3.
- The condition may also be related to an inflammatory process affecting the vascular bed, and acute vasospasm of small vessels may precede abruption 3.
Risk Factors and Consequences
- Several risk factors are associated with placental abruption, including maternal age, parity, and history of previous abruption 5.
- The consequences of placental abruption can be severe, including maternal morbidity and perinatal mortality, low birthweight, preterm delivery, asphyxia, stillbirth, and perinatal death 5.