Contents
Complete/partial detachment of the placenta before delivery,
- Usually after 20 weeks of gestation
- M/C cause of APH
- M/C cause of late pregnancy bleeding
- M/C obstetric cause of DIC
- 1% pregnancy worldwide
- MEDICAL EMERGENCY
Classification

- Partial separation (M/C)
- With concealed haemorrhage:
- With apparent haemorrhage
- Complete separation
Etiology
Risk factors:
- Previous placental abruption (M/C risk factor)
- Hypertensive pregnancies (#2 M/C risk factor)
- Trauma (#3 M/C cause)
- Toxic metabolites (#4 M/C cause): Alcohol and cocaine use and cigarette smoking
- Intrauterine growth restriction (IUGR)
- Advancing maternal age
- Male fetuses
- Short umbilical cord (traction during delivery)
- Prolonged rupture of membranes (>24 hours)
- Thrombophilia
- Polyhydramnios (sudden release of ↑ amniotic fluid)
- Multiparity
- Multiple pregnancy
Pathophysiology
Etiology
(Smoking, HTN, trauma, etc)
↓
Arterial degeneration
(at centre of placenta)
↓
Hemorrhage
↓
Separation of placenta
↓
Reduced O2 delivery
(up to 25% reduction can be compensated)
↓
Expansion of bleed (central bleed) or vaginal bleeding (marginal bleed)
↓
↓ surface of O2 exchange & ↓ maternal BP
↓
↓ O2 delivery
↓
(Prolonged O2 deprivation)
↓
Fetal organ damage
Presentation
Placental abruption usually presents as a combination of vaginal bleeding, uterine contractions, and pain.
- Sudden-onset pain (abdomen + back) (from contractions d/t release of thromboplastin)
- Pain present between contractions
Concealed abruptio:
- Firm, tender, enlarged uterus (disproportionate to gestational age of fetus)
- Decreased fetal movement
- Decreased fetal heart rate
Page’s classification:

Complications
- MATERNAL
- Sheehan Syndrome
- Perinatal pituitary necrosis
- Renal failure
- Disseminated Intravascular Coagulation (DIC) #1
- Due to ↑ Thromboplastin release from placenta
- Sheehan Syndrome
- FETAL
- Intrauterine hypoxia & asphyxia
- Premature birth #2
- Hypovolemic shock (Maternal and/or fetal) #3
- Death
- Maternal (0.5-5%)
- Fetal (35-80%)
Diagnosis
Transabdominal ultrasound:
Investigation of choice

Management
- Maternal/fetal risk → C-section
- Term & stable → Vaginal delivery
- Preterm & stable → Admit & observation