Abruptio placentae is premature separation of a normally implanted placenta from the uterus after 20 wk gestation. It is an obstetric emergency. Manifestations may include vaginal bleeding, uterine pain and tenderness, hemorrhagic shock, and disseminated intravascular coagulation. Diagnosis is clinical and sometimes by ultrasonography. Treatment is bed rest for mild symptoms and prompt delivery for severe or persistent symptoms.
Abruptio placentae occurs in 0.4 to 1.5% of all pregnancies; incidence peaks at 24 to 26 wk gestation.
Abruptio placentae may involve any degree of placental separation, from a few millimeters to complete detachment. Separation can be acute or chronic. Separation results in bleeding into the decidua basalis behind the placenta (retroplacentally). Cause is unknown.
Risk factors include the following:
Complications include the following:
Symptoms and Signs
Acute abruptio placentae may result in bright red blood exiting through the cervix (external hemorrhage). Blood may also remain behind the placenta (concealed hemorrhage). Severity of symptoms and signs depends on degree of separation and blood loss. As separation continues, the uterus may be painful, tender, and irritable to palpation. Hemorrhagic shock may occur, as may signs of DIC. Chronic abruptio placentae may cause continued or intermittent dark brown spotting.
Abruptio placentae may cause no or minimal symptoms and signs.
Diagnosis is suggested if any of the following occur during late pregnancy:
The diagnosis should also be considered in women who have had abdominal trauma. If bleeding occurs during late pregnancy, placenta previa, which has similar symptoms, must be ruled out before pelvic examination is done; if placenta previa is present, examination may increase bleeding.
Evaluation includes the following:
Fetal heart monitoring may detect a nonreassuring pattern or fetal death.
Transvaginal ultrasonography may be done if transabdominal ultrasonography rules out placenta previa. However, ultrasonography is insensitive; thus, diagnosis may ultimately be clinical.
Prompt cesarean delivery is usually indicated if any of the following is present:
However, oxytocin may be given to accelerate vaginal delivery, depending on the stage of labor and the rapidity of maternal and fetal deterioration (eg, oxytocin may be given if delivery appears imminent and the mother and fetus are stable). Amniotomy (deliberate rupture of membranes) is done early because it may accelerate delivery, preventing DIC.
Hospitalization and bed rest are advised if all of the following are present:
This approach ensures that mother and fetus can be closely monitored and, if needed, rapidly treated. Corticosteroids should be considered (to accelerate fetal lung maturity) if gestational age is < 34 wk. If bleeding resolves and maternal and fetal status remains stable, ambulation and usually hospital discharge are allowed. If bleeding continues or if status deteriorates, prompt cesarean delivery is indicated.
Complications (eg, shock, DIC) are managed with aggressive replacement of blood and blood products.
Last full review/revision February 2010 by Antonette T. Dulay, MD
Content last modified February 2010