Abruptio Placentae

Abruptio placentae (placental abruption) refers to separation of a normally located placenta before birth of the fetus. This event occurs in 1 in 129 births. Severe abruption results in a fetal mortality of 0.2%. Bleeding into the decidua basalis leads to separation of the placenta. Hematoma formation further separates the placenta from the uterine wall and compresses these structures, compromising the blood supply to the fetus leading to increased intrauterine pressure, uterine tenderness, frequent uterine contractions, fetal distress, and demise. The severity of fetal distress correlates with the degree of placental separation.

When the abruption is extensive, retroplacental blood may penetrate the thickness of the uterine wall into the peritoneal cavity because of increased intrauterine pressure. This phenomenon is called "couvelaire uterus." The myometrium becomes weakened and rarely may rupture, leading immediately to a life-threatening obstetric emergency. In near-complete or complete abruption, fetal death is inevitable unless immediate delivery by cesarean section is performed. Abrup-tio placentae received renewed awareness with the causal relationship to cocaine (Kline, 1997).

Abruptio placentae is a clinical diagnosis. Painful vaginal bleeding in the third trimester is the hallmark. Because ultrasound for this disorder has a high false-negative rate, this complication is diagnosed primarily on the findings of vaginal bleeding, abdominal pain, uterine tenderness, uterine contractions, and fetal distress. In one prospective study, almost 80% of patients with abruptio placentae presented with vaginal bleeding, 66% with uterine or back pain, and 60% with fetal distress (Hurd et al., 1983). Other evidence of abruptio placentae can include idiopathic preterm labor, uterine hypertonicity, and fetal demise. The monitoring of uterine contractions may reveal a high baseline pressure with concurrent contractions often 1 to 2 minutes apart.

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