Placental abruption

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[1]
Complications	Mother: disseminated intravascular coagulopathy, kidney failure[2] Baby: low birthweight, preterm delivery, stillbirth[2]
Usual onset	24 to 26 weeks of pregnancy[2]
Causes	Unclear[2]
Risk factors	Smoking, preeclampsia, prior abruption[2]
Diagnostic method	Based on symptoms, ultrasound[1]
Differential diagnosis	Placenta previa, bloody show, chorioamnionitis[3]
Treatment	Bed rest, delivery[1]
Medication	Corticosteroids[1]
Frequency	~0.7% of pregnancies[2]

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth.^[2] It occurs most commonly around 25 weeks of pregnancy.^[2] Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure.^[1] Complications for the mother can include disseminated intravascular coagulopathy and kidney failure.^[2] Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.^[2][3]

The cause of placental abruption is not entirely clear.^[2] Risk factors include smoking, pre-eclampsia, prior abruption (most important and predictive risk factor), trauma during pregnancy, cocaine use, and previous cesarean section.^[2][1] Diagnosis is based on symptoms and supported by ultrasound.^[1] It is classified as a complication of pregnancy.^[1]

For small abruption, bed rest may be recommended, while for more significant abruptions or those that occur near term, delivery may be recommended.^[1][4] If everything is stable, vaginal delivery may be tried, otherwise cesarean section is recommended.^[1] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby's lungs.^[1] Treatment may require blood transfusion or emergency hysterectomy.^[2]

Placental abruption occurs in about 1 in 200 pregnancies.^[5] Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy.^[6] Placental abruption is the reason for about 15% of infant deaths around the time of birth.^[2] The condition was described at least as early as 1664.^[7]