Abruption of Placenta

Abruption Placentae or Placental Abruption is the premature separation of a normally implanted placenta from the uterus.

Incidence

It is seen in females of childbearing age group. An interval of 10 years or more between births may cause an increased incidence in the subsequent pregnancies.

Cause

The condition is caused by the sudden decompression of the uterus in cases of rupture of membranes in patients with polyhydramnios or after delivery of the first of multiple foetuses.

The common causes include trauma of variable amounts, hydraminos and twin gestation.

Risk Factors

The common risk factors include maternal smoking, multiparity (>3), alcohol abuse, hypertension, short umbilical cord and preterm rupture of membranes.

Symptoms

Placental abruption classically presents as painful vaginal bleeding with a firm tender uterus in the third trimester. Other symptoms include back pain, abdominal pain, constant uterine pain (with or without contractions), uterine tenderness, blood loss and tachycardia.

Blood loss increase in pregnancy and vital signs may be preserved even with heavy loss. Blood loss may be concealed and the clinical signs of shock can exceed the estimated loss of blood.

Grades

(Grade 1) minimal or no bleeding, detected as retro-placental clot after delivery of viable foetus. (Grade 2) viable foetus with bleeding and tender irritable uterus. (Grade 3 Type A) dead foetus and no coagulopathy. (Grade 3 Type B) dead foetus and coagulopathy.

Diagnosis

An ultrasound should be done prior to vaginal exam. The commonest hematological finding in placental abruption is hypo-fibrinogenaemia. Diastolic pressure increases with narrowed pulse pressure.

Foetal heart sounds and palpitation also becomes difficult.

Complications

The mother and the foetus may die of haemorrhage and further contractions may worsen the abruption.

Abruption is also the most common cause of consumptive coagulopathy in pregnancy; therefore; transfusions should be given to those patients requiring it with close follow-up of the coagulation status. It is also the commonest cause of acute renal failure in pregnancy.