Placental Abruption, Ob/Gyne Seminar Block 4.3 Life Cycle III College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia

1. Placental Abruption
Abdullatiff Sami Al-Rashed
212516770
Block 4.3 Life Cycle III
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. Course Coordinator

3. Objectives
• Definition.
• Etiology.
• Clinical Presentation.
• Diagnosis.
• Management.
• Complications.

4. Definition
• Placental Abruption “Abruptio placenta” is a
premature separation of a normally implanted
placenta.
• Typically reserved for pregnancies over 20
weeks of gestation.

5. Etiology

6. Clinical Presentation

7. Clinical Presentation
• The severity of the clinical presentation is
variable:
1.Partial placental abruption:
• In which no maternal or fetal compromise is noted.
1.Complete placental abruption:
• with profuse bleeding, signs of maternal DIC, and a stillbirth.

9. Diagnosis
THE BASIS OF DIAGNOSIS CONSISTS
OF HISTORY, CLINICAL EXAMINATION,
AND A HIGH INDEX OF SUSPICION.
THE BASIS OF DIAGNOSIS CONSISTS
OF HISTORY, CLINICAL EXAMINATION,
AND A HIGH INDEX OF SUSPICION.

10. Diagnosis
• Fetal heart rate monitoring:
– May reveal loss of variability or may have late
decelerations.
– The uterine tone may be increased without
periods of relaxation.

11. Diagnosis
• Ultrasound:
– Confirmation occurs only in 25% of cases.
– A retroplacental clot may not be detected
unless a very large abruption occurs.

13. Diagnosis
• Laboratory tests:
– Nonspecific but may reveal
thrombocytopenia, hypofibrinogenemia
(≤200 mg/dL), and anemia.
– Remember a normal fibrinogen level in a
pregnant woman is higher than normal,
around 400 mg/dL.

15. Management
• Maternal hospitalization with continuous fetal monitoring and close
surveillance of maternal status:
– Delivery may be delayed in the preterm fetus if the fetal heart
rate tracing is reassuring and the maternal condition remains
stable.
– Immediate cesarean delivery is necessary in the following
conditions:
• (1) Fetal heart rate tracing is nonreassuring.
• (2) Maternal hemodynamic instability.
– Vaginal delivery is desirable if the maternal and fetal condition
permits.

16. Management
• Tocolytic Drugs:
• The use of tocolytic drugs is controversial in the setting
of placenta abruption in a pregnancy less than 34 weeks.
• If tocolysis is to be considered, maternal and fetal status
must be reassuring.
– Magnesium sulfate is the tocolytic of choice because of its
efficacy and side effect profile.
– Prostaglandin inhibitors should be used with caution because
they are associated with a theoretic risk of platelet dysfunction.

17. Complications
Complication Cause
Hemorrhagic shock May occur either from external
bleeding or from concealed clots.
Consumptive coagulopathy (DIC) may occur in 30% of cases of
severe abruptio placentae
Renal failure May result from intrarenal
vasospasm or from massive
hemorrhage and hypotension.
Fetal maternal hemorrhage more commonly seen with traumatic
instances of abruptio placentae.
Couvelaire uterus results from extravasation of blood
into the myometrium.

18. Quizzes
• 1. A 39-year-old woman, gravida 2, para 1, at 36 and 4/7th weeks of
gestation with a history of prior cesarean section in the setting of placental
abruption presents with abdominal pain and vaginal bleeding. She admits
to using cocaine. Her vital signs are significant for T 􏰁 99.9, HR 􏰁 120,
BP 􏰁 170/100. Fetal heart rate baseline is in the 160s with minimal
variability and repetitive late decelerations. Her bloodwork is significant for
a hemoglobin of 7.5, platelets of 110,000, and a fibrinogen level of 250
mg/ dL. All of the following are risk factors for this patient’s condition
except:
• A Advanced maternal age
• B Cocaine
• C Prior cesarean section
• D Hypertension
• E Prior placental abruption

19. Quizzes
• 2. A 33-year-old woman, gravida 7, para 4, presents at
28 weeks with complaints of vaginal bleeding. She
denies abdominal or back pain. She has had no prenatal
care. She reports recent intercourse. On presentation,
she has light vaginal bleeding and fetal heart tones are
reassuring. The most useful next step in her evaluation
would be:
• A Digital examination
• B Complete blood count (CBC), coagulation profile
• C Ultrasound
• D Immediate cesarean delivery
• E A double set-up examination

20. References