Placental abruption | |
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Other names | Abruptio placentae |
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Drawing of internal and external bleeding from placental abruption | |
Specialty | Obstetrics |
Symptoms | Vaginal bleeding, low abdominal pain, dangerously low blood pressure[1] |
Complications | Mother: disseminated intravascular coagulopathy, kidney failure[2] Baby: low birthweight, preterm delivery, stillbirth[2] |
Usual onset | 24 to 26 weeks of pregnancy[2] |
Causes | Unclear[2] |
Risk factors | Smoking, preeclampsia, prior abruption[2] |
Diagnostic method | Based on symptoms, ultrasound[1] |
Differential diagnosis | Placenta previa, bloody show, chorioamnionitis[3] |
Treatment | Bed rest, delivery[1] |
Medication | Corticosteroids[1] |
Frequency | ~0.7% of pregnancies[2] |
Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth.[2] It occurs most commonly around 25 weeks of pregnancy.[2] Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.[1] Complications for the mother can include disseminated intravascular coagulopathy and kidney failure.[2] Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.[2][3]
The cause of placental abruption is not entirely clear.[2] Risk factors include smoking, pre-eclampsia, prior abruption (most important and predictive risk factor), trauma during pregnancy, cocaine use, and previous cesarean section.[2][1] Diagnosis is based on symptoms and supported by ultrasound.[1] It is classified as a complication of pregnancy.[1]
For small abruption, bed rest may be recommended, while for more significant abruptions or those that occur near term, delivery may be recommended.[1][4] If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended.[1] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs.[1] Treatment may require blood transfusion or emergency hysterectomy.[2]
Placental abruption occurs in about 1 in 200 pregnancies.[5] Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy.[6] Placental abruption is the reason for about 15% of infant deaths around the time of birth.[2] The condition was described at least as early as 1664.[7]