From the Guidelines
Placental abruption is a life-threatening emergency that presents with vaginal bleeding, abdominal or back pain, uterine tenderness or rigidity, and frequent contractions, and requires immediate medical attention to prevent severe morbidity and mortality. The symptoms of placental abruption can vary in severity, but typically include:
- Vaginal bleeding, which may be visible or concealed
- Abdominal or back pain
- Uterine tenderness or rigidity
- Frequent contractions
- Signs of maternal shock, such as rapid heart rate, low blood pressure, and dizziness
- Fetal distress, indicated by abnormal heart rate patterns 1. Risk factors for placental abruption include hypertension, trauma, substance use, advanced maternal age, and previous abruption 1. The condition occurs when the placenta partially or completely separates from the uterine wall before delivery, disrupting oxygen and nutrient supply to the fetus and potentially causing severe maternal hemorrhage 1. Treatment typically involves immediate hospitalization, continuous monitoring, and often emergency delivery depending on gestational age and the severity of the abruption 1. It is essential to note that placental abruption can have long-term consequences, including an increased risk of future cardiovascular disease 1. Therefore, any pregnant woman experiencing sudden abdominal pain with or without bleeding should seek immediate medical attention to prevent severe morbidity and mortality.
From the Research
Placental Abruption Signs and Symptoms
- The clinical manifestations of placental abruption typically include vaginal bleeding and abdominal pain with a wide variety of abnormal fetal heart rate patterns 2.
- Clinical manifestations also include uterine contractions and abnormalities in the fetal heart rate tracing 3.
- The classic clinical triad of placental abruption is present in only a small percentage of cases, approximately 4% 4.
- Vaginal bleeding is a common sign of placental abruption, and it can be profound, necessitating urgent delivery 2, 5.
- Abdominal pain is another common symptom, and it can be accompanied by uterine contractions 3.
Diagnosis and Management
- The diagnosis of placental abruption is a clinical one, and ultrasonography and the Kleihauer-Betke test are of limited value 5.
- Sonographic findings of abruption and fetal heart rate tracings are presented, but the diagnosis is primarily based on clinical presentation 2.
- Management of placental abruption should be individualized on a case-by-case basis depending on the severity of the abruption and the gestational age at which it occurs 5, 3.
- In cases where fetal demise has occurred, vaginal delivery is preferable, and disseminated intravascular coagulopathy should be managed aggressively 5.
Epidemiology and Risk Factors
- Placental abruption occurs in approximately 0.4-1.0% of all pregnancies 3, 6.
- 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 5, 6.
- The prevalence of placental abruption is lower in the Nordic countries compared to the USA 6.
- Placental abruption is a leading cause of vaginal bleeding in the second half of pregnancy and is associated with significant maternal and perinatal morbidity and mortality 2, 5, 6.