What are the causes of intraplacental hemorrhage?

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Causes of Intraplacental Hemorrhage

Intraplacental hemorrhage (also known as Kline's hemorrhage or intervillous hemorrhage) is caused by maternal vascular pathology including thrombophilia, microangiopathy, antiphospholipid syndrome, disseminated intravascular coagulopathy, and severe preeclampsia, which lead to microembolism and bleeding within the placental substance itself. 1

Primary Etiologic Mechanisms

Intraplacental hematomas represent a distinct pathologic entity from other placental bleeding patterns and arise from:

  • Thrombophilic disorders that cause microembolism within placental vessels 1
  • Microangiopathy diseases affecting the small vessels within the placental parenchyma 1
  • Antiphospholipid syndrome leading to thrombosis and subsequent hemorrhage in placental tissue 1
  • Disseminated intravascular coagulopathy (DIC) causing widespread microvascular thrombosis and bleeding 1
  • Severe preeclampsia with associated endothelial dysfunction and vascular injury 1

Clinical Significance and Outcomes

Intraplacental hematomas carry a distinctly worse prognosis compared to other hematoma locations:

  • Second-trimester miscarriage occurs in 9.4% of pregnancies with intraplacental hematomas, significantly higher than retroplacental hematomas (4.2%) or controls (0%) 2
  • Placental insufficiency develops at the highest rates in intraplacental hematoma cases, with intraplacental location serving as an independent predictor (β = 4.19, p < 0.001) 2
  • Intrauterine growth restriction (IUGR) is independently predicted by intraplacental hematomas (β = 1.44, p = 0.035) 2
  • Preterm delivery <37 weeks and early preterm delivery <34 weeks occur most frequently with intraplacental hematomas compared to other hematoma locations 2
  • Premature preterm rupture of membranes (PPROM) and preterm labor are significantly elevated in this population 2

Diagnostic Considerations

The pathologic appearance includes:

  • Multiple intraplacental cavernae containing semifluid blood and fresh coagula on gross examination 1
  • Intervillous hemorrhage visible on histopathologic examination 1
  • Hematomas classified by location as retroplacental, marginal subchorionic, preplacental (subamniotic), or intraplacental on imaging 3

Critical Clinical Pitfalls

  • Do not confuse intraplacental hematomas with retroplacental hematomas (abruption): While both cause bleeding, intraplacental hematomas have different risk profiles and are independent predictors of placental insufficiency and IUGR, whereas intrauterine fetal deaths occur only with retroplacental hematomas 2
  • Recognize the maternal vascular etiology: Unlike traumatic placental abruption, intraplacental hemorrhage stems from underlying maternal thrombotic or vascular disorders requiring specific workup 1
  • MRI can characterize hematoma age and differentiate hematomas from tumors when ultrasound findings are equivocal 3

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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