Limbic 365Abruptio placentae, also known as placental abruption, is a serious medical condition in which the placenta partially or completely separates from the uterus before the delivery of the baby. This separation can cause life-threatening bleeding and deprive the baby of oxygen and nutrients. It is a rare complication occurring in about 1% of pregnancies, but it is a leading cause of maternal and fetal morbidity and mortality.
Pathophysiology:
The exact cause of abruptio placentae is not known, but it is thought to be related to vascular abnormalities in the placenta, high blood pressure, smoking, trauma, uterine overdistension, and cocaine use. In this condition, the separation of the placenta from the uterus results in bleeding, which can be concealed or visible. A concealed bleed is when the blood pools between the placenta and the uterus, while a visible bleed is when the blood flows out of the vagina. The severity of abruptio placentae depends on the degree of separation and the amount of bleeding.
Signs and Symptoms:
The classic presentation of abruptio placentae is sudden onset of vaginal bleeding, often accompanied by abdominal pain and uterine contractions. However, in some cases, the bleeding may be concealed, and the patient may not experience any symptoms. The severity of symptoms depends on the extent of separation and the amount of bleeding. The patient may experience symptoms of shock, such as low blood pressure, rapid heartbeat, and decreased urine output.
Investigations:
The diagnosis of abruptio placentae is based on the clinical presentation and supported by ultrasound examination. The ultrasound can confirm the diagnosis by showing the separation of the placenta from the uterine wall and the presence of a blood clot between the placenta and the uterus.
Treatment:
The management of abruptio placentae depends on the severity of the condition and the gestational age of the fetus. In cases of mild to moderate separation and stable maternal and fetal condition, conservative management with close monitoring may be indicated. However, in cases of severe separation and fetal distress, prompt delivery by caesarean section is recommended to save the life of the mother and the baby. Blood transfusions, intravenous fluids, and other supportive measures may be required to stabilize the patient’s condition.
Dos and Don’ts:
In case of abruptio placentae, the patient should be immediately transferred to a hospital equipped with a neonatal intensive care unit and a blood bank. The patient should avoid any physical activity and follow the doctor’s instructions strictly. Smoking, alcohol, and drugs should be strictly avoided during pregnancy, as they increase the risk of placental abruption.
Reference:
Ananth CV, Wilcox AJ. Placental Abruption and Perinatal Mortality. Epidemiology. 2001;12(6):598-603. doi:10.1097/00001648-200111000-00003.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):e1-e25. doi:10.1097/AOG.0000000000003010.
Royal College of Obstetricians and Gynaecologists. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27a. RCOG; 2018.
