Placental abruption differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:Rana aljebzi, M.D.[2]

Overview

Bleeding during the second half of pregnancy is usually due to either placental abruption or placenta previa. Differentiating these 2 conditions is important to the care of the patient.

differential diagnosis

Placental abruption is an important cause of antenatal haemorrhage, Differential diagnoses to consider include:

• Placenta praevia : where the placenta is fully or partially attached to the lower uterine segment.
• Subchorionic Hemorrhage: is bleeding between the amniotic sac (membranes) and the uterine wall.This can occur by the placenta disconnecting from the original site of implantation, resulting in bleeding of the chorionic membranes, the outer layer of the amniotic sac.
• Vasa praevia: which is extremely rare but devastating condition in which fetal umbilical cord blood vessels cross or run in close to the inner cervical os.
• Uterine rupture : This usually occurs in labour with a history of previous caesarean section or previous uterine surgery such as myomectomy, where the full-thickness disruption of the uterine muscle and overlying serosa.
• Local genital causes:
  • Benign or malignant lesions :e.g. polyps, carcinoma. cervical ectropion (common).
  • Infections : e.g. candida, bacterial vaginosis and chlamydia.