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| {{Infobox_Disease
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| | Name = {{PAGENAME}}
| | '''For patient information, click [[Placental abruption (patient information)|here]]''' |
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| | DiseasesDB = 40
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| | ICD10 = {{ICD10|O|45||o|30}}
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| | ICD9 = {{ICD9|641.2}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000901
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| | eMedicineSubj = med
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| | eMedicineTopic = 6
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| | eMedicine_mult = {{eMedicine2|emerg|12}} |
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| | MeshID = D000037
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| {{SI}}
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| {{CMG}}
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| {{EH}} | | {{Placental abruption}} |
| | {{CMG}}; '''Associate Editor-In-Chief:''' [[User:zorkun|Cafer Zorkun]] M.D., PhD. |
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| ==Overview==
| | {{SK}} Premature separation of placenta; ablatio placentae; abruptio placentae; placenta abruptio |
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| '''Placental abruption''' (Also known as '''abruptio placentae''') is a [[complication of pregnancy]], wherein the [[placenta]]l lining has separated from the [[uterus]] of the [[mother]]. It is the most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of [[pregnancy|pregnancies]] world wide with a fetal mortality rate of 20-40% depending on the degree of separation. Placental abruption is also a significant contributor to maternal mortality.
| | ==[[Placental abruption overview|Overview]]== |
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| The heart rate of the fetus can be associated with the severity.<ref name="pmid17896112">{{cite journal |author=Usui R, Matsubara S, Ohkuchi A, ''et al'' |title=Fetal heart rate pattern reflecting the severity of placental abruption |journal= |volume= |issue= |pages= |year=2007 |pmid=17896112 |doi=10.1007/s00404-007-0471-9}}</ref>
| | ==[[Placental abruption historical perspective|Historical Perspective]]== |
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| == Lasting effects == | | ==[[Placental abruption classification|Classification]]== |
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| '''On the mother:'''
| | ==[[Placental abruption pathophysiology|Pathophysiology]]== |
| *A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
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| *The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract.
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| *The mother may have problems with blood clotting for a few days.
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| *If the mother's blood does not clot (particularly during a [[caesarean section]]) and too many transfusions could put the mother into [[disseminated intravascular coagulation]] (DIC), the doctor may consider a [[hysterectomy]].
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| *A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland.
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| *In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported.
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| '''On the baby:'''
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| *If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery.
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| *The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding.
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| *If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth.
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| *The newborn may have low blood pressure or a low blood count.
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| *If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.
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| == Symptoms == | | ==[[Placental abruption causes|Causes]]== |
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| * contractions that don't stop
| | ==[[Placental abruption differential diagnosis|Differentiating Placental Abruption from other Diseases]]== |
| * pain in the uterus
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| * tenderness in the abdomen
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| * vaginal bleeding (sometimes)
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| == Pathophysiology == | | ==[[Placental abruption epidemiology and demographics|Epidemiology and Demographics]]== |
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| [[Physical trauma|Trauma]], [[hypertension]], or [[coagulopathy]], contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the [[decidua basalis]]. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption. | | ==[[Placental abruption risk factors|Risk Factors]]== |
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| Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, [[fetal distress]] or death.
| | ==[[Placental abruption screening|Screening]]== |
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| Abruptions are classified according to severity in the following manner:
| | ==[[Placental abruption natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| *'''Grade 0''': Asymptomatic and only diagnosed through post partum examination of the placenta.
| | ==Diagnosis== |
| *'''Grade 1''': The mother may have vaginal bleeding with mild uterine tenderness or tetany, but there is no distress of mother or fetus.
| | [[Placental abruption history and symptoms|History and Symptoms]] | [[Placental abruption physical examination|Physical Examination]] | [[Placental abruption laboratory findings|Laboratory Findings]] | [[Placental abruption CT|CT]] | [[Placental abruption MRI|MRI]] | [[Placental abruption ultrasound|Ultrasound]] | [[Placental abruption other imaging findings|Other Imaging Findings]] | [[Placental abruption other diagnostic studies|Other Diagnostic Studies]] |
| *'''Grade 2''': The mother is symptomatic but not in shock. There is some evidence of fetal distress can be found with fetal heart rate monitoring.
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| *'''Grade 3''': Severe bleeding (which may be occult) leads to maternal shock and fetal death. There may be maternal [[disseminated intravascular coagulation]]. Blood may force its way through the uterine wall into the serosa, a condition known as [[Couvelaire uterus]].
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| == Risk factors == | | ==Treatment== |
| | [[Placental abruption medical therapy|Medical Therapy]] | [[Placental abruption surgery|Surgery]] | [[Placental abruption primary prevention|Primary Prevention]] | [[Placental abruption secondary prevention|Secondary Prevention]] | [[Placental abruption cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Placental abruption future or investigational therapies|Future or Investigational Therapies]] |
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| * Maternal [[hypertension]] is a factor in 44% of all abruptions.
| | == Case Studies == |
| * Maternal trauma, such as motor vehicle accidents, assaults, falls, or [[nosocomial]]
| | [[Placental abruption case study one|Case #1]] |
| * Drug use is a factor, particularly [[tobacco]], [[alcohol]], and [[cocaine]].
| | [[es:Desprendimiento prematuro de placenta]] |
| * Short [[umbilical cord]]
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| * Prolonged rupture of membranes (>24 hours)
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| * Retroplacental fibromyoma
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| * Maternal age: pregnant women who are younger than 20 or older than 35 are at greater risk.
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| * Previous abruption: Women who have had an abruption in previous pregnancies are at greater risk.
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| The risk of placental abruption can be reduced by maintaining a good [[diet (nutrition)|diet]] including taking [[folic acid]], regular [[sleep]] patterns and not [[Tobacco smoking|smoking]] or drinking [[alcohol]].
| | [[Category:Disease]] |
| | | [[Category:Obstetrics]] |
| == Intervention ==
| | [[Category:Emergency medicine]] |
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| Placental abruption is suspected when a pregnant woman has sudden localized uterine pain with or without bleeding. The [[fundus (uterus)|fundus]] may be monitored because a rising fundus can indicate bleeding. An ultrasound may be used to rule out [[placenta previa]] but is not diagnostic for abruption. The mother may be given Rheogam if she is [[Blood type#Rhesus|Rh negative]].
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| Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks and neither mother or fetus are in any distress, then they may simply be monitored in hospital until a change in condition or fetal maturity whichever comes first.
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| Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement and to maintain blood pressure and [[blood plasma]] replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over [[caesarean section]] unless there is fetal distress. Caesarean section is contraindicated in cases of disseminated intravascular coagulation.
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| == References ==
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| <references/>
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| * {{cite book |author=Bobak, Irene M; Lowdermilk, Deitra Leonard; Perry, Shannon E. |title=Maternity & women's health care |publisher=Mosby |location=St. Louis |year=2000 |pages= |isbn=0-323-00961-1 |oclc= |doi=}}
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| == External links ==
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| * Emergency medicine: [http://www.emedicine.com/emerg/topic12.htm Abruptio Placentae], ''emedicine.com'', April 5, 2005
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| * Obstetrics/Gynecology: [http://www.emedicine.com/med/topic6.htm Abruptio Placentae], ''emedicine.com'', August 31, 2005
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| {{Pathology of pregnancy, childbirth and the puerperium}}
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| [[Category:Pregnancy]] | |
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| [[es:Desprendimiento prematuro de placenta]] | |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |