Placental Abruption

Separation of the placentaeither partially or totallyfrom its implantation site before delivery
Placental abruption
is initiated by hemorrhage into the decidua basalis. The decidua then splits,
leaving a thin layer adhered to the myometrium. Consequently, the process begins as a decidual
hematoma and expands to cause separation and compression of the adjacent placenta the blood is retained between
the detached placenta and the uterus, leading to concealed hemorrhage and delayed diagnosis
With concealed hemorrhage, the likelihood of consumptive coagulopathy also is greater
Traumatic Abruption. External traumausually from motor vehicle accidents or aggravated assault
Placental abrubtion.Perinatal morbidityoften severeis common in survivors.
Predisposing Factors
Maternal age, great parity , women of great parity race or ethnicity familial association
RISK FACTORS
Hypertension and Preeclampsia. Some form of hypertension is the most frequent condition
associated with placental abruption. This includes gestational hypertension, preeclampsia, chronic hypertension, or a
combination thereof
Uterine Leiomyomas. Especially if located near the mucosal surface behind the placental
implantation site, uterine myomas can predispose to abortion or later to placental abruption
Recurrent Abruption.
woman who has suffered an abruptionespecially one that caused fetal deathhas an
extraordinarily high risk for recurrence.
PLACENTAL ABRUPTION.In some women, external bleeding can be profuse, yet placental separation may not be
so extensive as to compromise the fetus. In others, there may be no external bleeding, but the placenta is sufficiently
sheared off that the fetus is deada concealed abruption.

PLACENTAL ABRUPTION. serum levels of alpha-fetoprotein > 280 g/L have a positive-predictive value of 97
percent.
PLACENTAL ABRUPTION
, pain from abruption may mimic normal labor, or it may be painless, especially with a
posterior placenta.

placental abruption was an all-too-common cause of acute kidney injury requiring dialysis
Consumptive Coagulopathy. Obstetrical eventsmainly placental abruption and amnionic-fluid
embolismled to the initial recognition of defibrination syndrome

PLACENTAL ABRUPTION.An important consequence of intravascular coagulation is the activation of

plasminogen to plasmin,
which lyses fibrin microemboli to maintain microcirculatory patency.

Consumptive coagulopathy is more likely with a concealed abruption because intrauterine pressure
is higher, thus forcing more thromboplastin into the large veins draining the implantation site

In obstetrics, it is most commonly

seen in cases of severe placental abruption in which treatment of hypovolemia is delayed or
incomplete.