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