Materiały źródłowe

• #1 Placental abruption – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458

  Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. […] Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. […] Seek emergency care if you have signs or symptoms of placental abruption.

• #2 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #3 Abruptio Placentae: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/252810-overview

  Abruptio placentae is defined as the premature separation of the placenta from the uterus. Patients with abruptio placentae, also called placental abruption, typically present with bleeding, uterine contractions, and fetal distress. A significant cause of third-trimester bleeding associated with fetal and maternal morbidity and mortality, placental abruption must be considered whenever bleeding is encountered in the second half of pregnancy. […] A diagnosis of class 0 is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta. […] The primary cause of placental abruption is usually unknown, but multiple risk factors have been identified. […] The frequency of abruptio placentae in the United States is approximately 1%, and a severe abruption leading to fetal death occurs in 0.12% of pregnancies (1:830).

• #4 Abruptio Placentae: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/252810-overview

  If the bleeding continues, fetal and maternal distress may develop. Fetal and maternal death may occur if appropriate interventions are not undertaken. […] The severity of fetal distress correlates with the degree of placental separation. In near-complete or complete abruption, fetal death is inevitable unless an immediate cesarian delivery is performed. […] The risk of recurrence of abruptio placentae is reportedly 4-12%. If the patient has abruptio placentae in 2 consecutive pregnancies, the risk of recurrence rises to 25%. […] A study by Pariente et al indicated that women who have placental abruption are at increased long-term risk for cardiovascular mortality.

• #5 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #6 How to Recognize Placental Abruption

  https://www.verywellhealth.com/placental-abruption-5184409

  Placental abruption is usually diagnosed based on symptoms, especially bleeding and abdominal pain. If your healthcare provider suspects a placental abruption, an ultrasound may be ordered. […] A definitive diagnosis can only be made after examination of the placenta following birth. A placenta that has abrupted will usually have an area of clotted blood. […] Bleeding during the second half of pregnancy can have other causes, like placenta previa. Your healthcare provider needs to differentiate between potential causes to identify the proper course of treatment. […] Placental abruption is diagnosed by symptoms, including vaginal bleeding. It may be treated with close monitoring or immediate delivery by vaginal birth or C-section.

• #7 Placental Abruption (Abruptio Placentae) – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placental-abruption-abruptio-placentae

  Placental abruption (abruptio placentae) is premature separation of the placenta from the uterus, usually after 20 weeks gestation. […] Diagnosis is clinical and sometimes by ultrasonography. […] The diagnosis of placental abruption is suspected if any of the following occur after the first trimester: vaginal bleeding, uterine pain and tenderness, fetal distress or death, hemorrhagic shock, DIC. […] Abnormal results of coagulation blood tests or fetal heart rate monitoring support the diagnosis. […] Ultrasonography can show some cases of placental abruption. However, findings with either type of ultrasonography may be normal in placental abruption. […] Diagnose based on characteristic symptoms and signs. […] Ultrasonography can show some cases of abruption; results of abnormal coagulation blood tests or fetal heart rate monitoring support the diagnosis.

• #8 Acute placental abruption: Pathophysiology, clinical features, diagnosis, and consequences – UpToDate

  https://www.uptodate.com/contents/acute-placental-abruption-pathophysiology-clinical-features-diagnosis-and-consequences

  Acute placental abruption: Pathophysiology, clinical features, diagnosis, and consequences […] Placental abruption is typically defined as the premature separation of the placenta from the decidua at or after 20 weeks gestation. The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by uterine contractions (including tachysystole), uterine tenderness, and a nonreassuring fetal heart rate pattern. Abruption is a significant cause of both maternal morbidity and neonatal morbidity and mortality, particularly when it occurs preterm. […] This topic will discuss the epidemiology, pathophysiology, etiology, clinical features, diagnosis, and consequences of abruption. […] DIAGNOSIS […] Clinical […] Mild versus severe […] Placental pathology.

• #9 Placental Abruption (Abruptio Placentae) – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/complications-of-pregnancy/placental-abruption-abruptio-placentae

  Placental abruption is the premature detachment of the placenta from the wall of the uterus at 20 weeks or more of pregnancy. […] Doctors diagnose placental abruption based on symptoms and sometimes do ultrasonography to confirm the diagnosis. […] Symptoms of placental abruption depend on the degree of detachment and the amount of blood lost (which may be massive). […] Doctors suspect and usually diagnose premature detachment of the placenta based on symptoms, such as vaginal bleeding and abdominal pain and tenderness. […] Ultrasonography may help doctors confirm the diagnosis of premature detachment and distinguish it from placenta previa, which can cause similar symptoms.

• #10 Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2814948/

  We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. […] The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The concordance between clinical and pathologic criteria for abruption diagnosis is poor. […] The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The most common indication leading to a clinical diagnosis of abruption was evidence of retroplacental clot(s) or bleeding (77.1%), followed by vaginal bleeding with uterine hypertonicity (27.8%) and by vaginal bleeding with nonreassuring fetal status (16.1%).

• #11 Placental Abruption or Abruptio Placenta – Dugan, Babij, Tolley & Kohler

  https://www.medicalneg.com/placental-abruption-or-abruptio-placenta/

  Placental abruption, also called abruptio placenta, is a condition where the placenta prematurely separates from the uterus. It is estimated that placental abruption occurs in approximately 1 in every 120 deliveries accounts for approximately 10 to 15 percent of fetal death. […] Several conditions have been recognized as being associated with an increased risk for a placental abruption. These include maternal hypertension, advanced maternal age and a prior history of placental abruption. […] Visible vaginal bleeding, typically associated with painful abdominal or back pain, is considered to be the most obvious sign of placental abruption. […] However, in a significant number of cases, placental abruptions can result in no visible vaginal bleeding. In such cases, the blood remains “concealed” and is retained between the detached placenta and the uterus. So-called “concealed” or “occult” placental abruptions require prompt and careful diagnosis and the expeditious implementation of medical treatment to reduce both maternal and fetal risks of injury and death.

• #12 Placental Abruption or Abruptio Placenta – Dugan, Babij, Tolley & Kohler

  https://www.medicalneg.com/placental-abruption-or-abruptio-placenta/

  Careful and safe obstetricians typically diagnose placental abruptions by evaluating both maternal and fetal clinical signs and symptoms. It has been recognized that abdominal ultrasounds are generally unhelpful in definitively identifying placental abruptions for the purpose of diagnosis. […] A placental abruption or abruptio placenta is considered a dire obstetrical emergency, potentially placing both the life of the mother and her baby at risk. […] Accordingly, the prompt diagnosis of a placental abruption is critical to the implementation of appropriate medical interventions, which often includes emergency cesarean delivery. […] Thus, the diagnosis of placental abruption must be made as expeditiously as possible so that reasonable precautions and medical interventions can be promptly implemented to avoid the possible life threatening risks for both mother and baby.

• #13 Placental Abruption: Causes, Symptoms, & Treatment

  https://my.clevelandclinic.org/health/diseases/9435-placental-abruption

  Placental abruption is a condition during pregnancy when the placenta separates from the uterus. A healthcare provider will diagnose and treat a placental abruption based on the severity of the separation and gestational age of the fetus. […] Your healthcare provider will diagnose placental abruption with an exam and other tests. You may be admitted to the hospital depending on the severity of the abruption or you may be able to rest at home. […] There are typically three grades, or classes, of placental abruption a healthcare provider will diagnose: Grade 1: Small amount of bleeding, some uterine contractions and no signs of stress to you or the fetus. This is usually a mild or partial placental abruption, meaning only part of the placenta is detached. Grade 2: Mild to moderate amount of bleeding, some uterine contractions and possible signs of fetal distress. Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions that dont relax, abdominal pain, low blood pressure and potential fetal death. […] Once the placenta has separated from the uterus, it cant be reconnected or repaired. A healthcare provider will recommend treatment based on the severity of the abruption.

• #14 Abruptio Placentae: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/252810-overview

  Abruptio placentae is defined as the premature separation of the placenta from the uterus. Patients with abruptio placentae, also called placental abruption, typically present with bleeding, uterine contractions, and fetal distress. A significant cause of third-trimester bleeding associated with fetal and maternal morbidity and mortality, placental abruption must be considered whenever bleeding is encountered in the second half of pregnancy. […] A diagnosis of class 0 is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta. […] The primary cause of placental abruption is usually unknown, but multiple risk factors have been identified. […] The frequency of abruptio placentae in the United States is approximately 1%, and a severe abruption leading to fetal death occurs in 0.12% of pregnancies (1:830).

• #15 Understanding placental abruption: causes, diagnosis and treatment

  https://seriousinjury.shoosmiths.com/medical-negligence/medical-negligence-guides/understanding-placental-abruption-causes-diagnosis-and-treatment

  Placental abruption is generally diagnosed when the mother displays one or more of the symptoms above. The diagnosis is confirmed by physical examination, which may include: […] Medical history and physical examination: Doctors will take a detailed medical history and perform a physical examination to check for signs of placental abruption. […] Ultrasound: An ultrasound scan helps to visualise the placenta and the extent of the separation. […] Fetal heart rate monitoring: Continuous electronic monitoring of the baby’s heart rate can identify distress. […] Blood tests: Blood tests check for anemia, clotting issues, and overall blood loss in the mother.

• #16 Placental abruption | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/placental-abruption

  Placental abruption means the placenta has detached from the wall of the uterus, either partly or totally. This can cause bleeding in the mother and may interfere with the babys supply of oxygen and nutrients. […] Without prompt medical treatment, a severe case of placental abruption can have dire consequences for the mother and her unborn child, including death. […] The symptoms and signs of placental abruption can mimic those of other pregnancy conditions, such as placenta praevia and preeclampsia. Information that may be used to diagnose placental abruption includes: Medical history, Physical examination, including checking the tenderness and tone of the uterus, Internal examination of the vagina and cervix, using a speculum, Blood tests, Ultrasound to check the placenta, Fetal heartbeat monitoring. […] Sometimes, the diagnosis of placental abruption cant be confirmed until childbirth, when the placenta is delivered with an attached blood clot that appears old rather than fresh. The placenta is usually sent to a laboratory for further diagnostic testing.

• #17 Placental abruption – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placental-abruption/diagnosis-treatment/drc-20376462

  If your health care provider suspects placental abruption, he or she will do a physical exam to check for uterine tenderness or rigidity. To help identify possible sources of vaginal bleeding, your provider will likely recommend blood and urine tests and ultrasound. […] During an ultrasound, high-frequency sound waves create an image of your uterus on a monitor. It’s not always possible to see a placental abruption on an ultrasound, however.

• #18 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #19 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  No laboratory studies have been shown to definitively help with the differential diagnosis of abruptio placentae; however, multiple laboratory studies may be helpful in the management of this problem. […] A fibrinogen level of less than 200 mg/dL suggests that the patient has a severe abruption. […] Some form of disseminated intravascular coagulation (DIC) is present in up to 20% of patients with severe abruptions. […] The quality and sensitivity of ultrasonography in detecting placental abruptions has improved significantly; however, it is not a sensitive modality for this purpose findings are positive in only 25% of cases confirmed at delivery, and the negative predictive value is low at around 50%. […] Ultrasonography can help to exclude other causes of third-trimester bleeding. Possible findings consistent with an abruption include (1) retroplacental clot (ie, hyperechoic to isoechoic in the acute phase, changing to hypoechoic within a wk), (2) concealed hemorrhage, or (3) expanding hemorrhage.

• #20 Treatment of placental abruption following blunt abdominal trauma: a case report

  https://jtraumainj.org/journal/view.php?number=1331

  Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. […] Ultrasonography revealed no clear evidence of placental abruption. […] Placental abruption is a severe traumatic event that can occur during pregnancy. It occurs in 1% of all pregnancies and is one of the most frequent causes of perinatal and maternal morbidity. […] Although ultrasonography is widely used in the initial evaluation of the fetus, its sensitivity for detecting placental abruption is only 24%, and false-negative findings of 50% have been reported. […] Placental abruption is clinically diagnosed and should be suspected when a patient presents with vaginal bleeding or abdominal pain after trauma. […] The optimal length of fetal monitoring following trauma is not clear, though the EAST guidelines recommend a minimum of 6 hours of cardiotocographic monitoring for pregnant women at 20 weeks of gestation. […] Even with minor trauma, abruption can occur, and it is important to maintain a high level of suspicion to detect the abruption.

• #21 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  No laboratory studies have been shown to definitively help with the differential diagnosis of abruptio placentae; however, multiple laboratory studies may be helpful in the management of this problem. […] A fibrinogen level of less than 200 mg/dL suggests that the patient has a severe abruption. […] Some form of disseminated intravascular coagulation (DIC) is present in up to 20% of patients with severe abruptions. […] The quality and sensitivity of ultrasonography in detecting placental abruptions has improved significantly; however, it is not a sensitive modality for this purpose findings are positive in only 25% of cases confirmed at delivery, and the negative predictive value is low at around 50%. […] Ultrasonography can help to exclude other causes of third-trimester bleeding. Possible findings consistent with an abruption include (1) retroplacental clot (ie, hyperechoic to isoechoic in the acute phase, changing to hypoechoic within a wk), (2) concealed hemorrhage, or (3) expanding hemorrhage.

• #22 Placental Abruption

  https://mobile.fpnotebook.com/OB/Bleed/PlcntlAbrptn.htm

  Premature placenta separation from uterine wall after 20 weeks gestation. […] Placental Abruption is a clinical diagnosis. […] Do not delay definitive management for Ultrasound. […] Ultrasound Test Sensitivity is only 50% for Placental Abruption. […] CT Test Sensitivity up to 100% (80% Specificity) when radiologists are cued to look for abruption. […] Placental Abruption is a clinical diagnosis. […] False Positive CT occur in up to 20% of patients (esp. second and third trimester pregnancy).

• #23 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #24 Placental abruption – Wikipedia

  https://en.wikipedia.org/wiki/Placental_abruption

  Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with or without bleeding. […] Diagnosis is based on symptoms and supported by ultrasound. […] An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. […] The diagnosis is one of exclusion, meaning other possible sources of vaginal bleeding or abdominal pain have to be ruled out in order to diagnose placental abruption. […] Of note, use of magnetic resonance imaging has been found to be highly sensitive in depicting placental abruption, and may be considered if no ultrasound evidence of placental abruption is present, especially if the diagnosis of placental abruption would change management.

• #25 Placental abruption | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/placental-abruption?lang=us

  Placental abruption (or abruptio placentae) refers to a premature separation of the normally implanted placenta after the 20th week of gestation and before the 3rd stage of labor. It is a potentially fatal complication of pregnancy and a significant cause of third-trimester bleeding/antepartum hemorrhage. […] Ultrasound is almost always the first (and usually the only) imaging modality used to evaluate placental abruption, but an index of suspicion should be maintained for the diagnosis since ultrasound is relatively insensitive for the diagnosis. […] MR imaging can accurately detect placental abruption and should be considered after negative US findings in the presence of late pregnancy bleeding if the diagnosis of abruption would change management. […] Given the low sensitivity for detecting placental abruption on ultrasound, if there is a high clinical suspicion, then it is likely prudent to treat based on the clinical suspicion.

• #26 Placental abruption – Wikipedia

  https://en.wikipedia.org/wiki/Placental_abruption

  Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with or without bleeding. […] Diagnosis is based on symptoms and supported by ultrasound. […] An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. […] The diagnosis is one of exclusion, meaning other possible sources of vaginal bleeding or abdominal pain have to be ruled out in order to diagnose placental abruption. […] Of note, use of magnetic resonance imaging has been found to be highly sensitive in depicting placental abruption, and may be considered if no ultrasound evidence of placental abruption is present, especially if the diagnosis of placental abruption would change management.

• #27 Placental abruption – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1117

  Placental abruption is the separation of the normally located placenta before delivery of the fetus. It may be concealed or overt. […] Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable. […] Key diagnostic factors include vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness. […] 1st investigations to order include fetal monitoring, Hb and haematocrit, coagulation studies, Kleihauer-Betke (K-B) test, and ultrasound.

• #28 Placental abruption | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placental-abruption

  Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have pain and serious bleeding. […] If your provider thinks you are having an abruption, you may need to get checked at the hospital. Your provider can look for abruption by doing a physical exam and an ultrasound. An ultrasound can find many, but not all, abruptions. Your provider will also monitor your baby’s heartbeat. […] Treatment depends on how serious the abruption is and how far along you are in your pregnancy. Your provider may simply monitor you and your baby. But sometimes you may need to give birth right away. […] If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. […] If you have a moderate to severe abruption, you are in a medical emergency and usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

• #29 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  A biophysical profile (BPP) can be used to help evaluate patients with chronic abruptions who are being managed conservatively. […] A modified BPP (nonstress test with amniotic fluid index) is sometimes used for monitoring in this situation. […] After delivery of the placenta, a retroplacental clot may be noted. Another possible finding involves extravasation of blood into the myometrium, which produces a purple discoloration of the uterine serosa. […] A study that included the data from 35,307 women and 250 cases of abruption reported abnormal pregnancy-associated plasma protein A, maternal serum alpha-fetoprotein, and inhibin-A analytes were associated with increased risk of abruption.

• #30 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  No laboratory studies have been shown to definitively help with the differential diagnosis of abruptio placentae; however, multiple laboratory studies may be helpful in the management of this problem. […] A fibrinogen level of less than 200 mg/dL suggests that the patient has a severe abruption. […] Some form of disseminated intravascular coagulation (DIC) is present in up to 20% of patients with severe abruptions. […] The quality and sensitivity of ultrasonography in detecting placental abruptions has improved significantly; however, it is not a sensitive modality for this purpose findings are positive in only 25% of cases confirmed at delivery, and the negative predictive value is low at around 50%. […] Ultrasonography can help to exclude other causes of third-trimester bleeding. Possible findings consistent with an abruption include (1) retroplacental clot (ie, hyperechoic to isoechoic in the acute phase, changing to hypoechoic within a wk), (2) concealed hemorrhage, or (3) expanding hemorrhage.

• #31 Placental abruption – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1117

  Placental abruption is the separation of the normally located placenta before delivery of the fetus. It may be concealed or overt. […] Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable. […] Key diagnostic factors include vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness. […] 1st tests to order include fetal monitoring, Hb and hematocrit, coagulation studies, Kleihauer-Betke (K-B) test, and ultrasound.

• #32 Placental Abruption | USF Health

  https://health.usf.edu/care/obgyn/services-specialties/mfm/placental-abruption

  When a placenta detaches from the uterine wall before the delivery of the baby. This occurs in approximately 1% of pregnancies. […] Tests that can confirm placental abruption include abdominal ultrasound, complete blood count, fetal monitoring, measuring levels of fibrinogen (protein that is essential for blood clot formation), pelvic exam, platelet count, and vaginal ultrasound.

• #33 ClinMed International Library | Placental Abruption Diagnosed by the Lab Technician | Obstetrics and Gynaecology Cases – Reviews

  https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-2-062.php?jid=ogcr

  Placental abruption is the separation of the placenta from the uterus. Diagnosis of placental abruption is largely a diagnosis of exclusion and ultrasound is not diagnostic. […] A search of relevant databases has not revealed a similar report. The conclusion is that, this must be the first report of an abruption being diagnosed upon finding two blood types within a group and save sample. […] The commonly used Kleihauer-Betke (KB) test has limited usefulness for detecting an abruption. It can however be used as a guide for the dose of Rh-immunoglobulin to administer in Rh negative women, as it is a test that detects the amount of fetal hemoglobin in the mothers blood and thus assess fetal-maternal hemorrhage (FMH).

• #34 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  No laboratory studies have been shown to definitively help with the differential diagnosis of abruptio placentae; however, multiple laboratory studies may be helpful in the management of this problem. […] A fibrinogen level of less than 200 mg/dL suggests that the patient has a severe abruption. […] Some form of disseminated intravascular coagulation (DIC) is present in up to 20% of patients with severe abruptions. […] The quality and sensitivity of ultrasonography in detecting placental abruptions has improved significantly; however, it is not a sensitive modality for this purpose findings are positive in only 25% of cases confirmed at delivery, and the negative predictive value is low at around 50%. […] Ultrasonography can help to exclude other causes of third-trimester bleeding. Possible findings consistent with an abruption include (1) retroplacental clot (ie, hyperechoic to isoechoic in the acute phase, changing to hypoechoic within a wk), (2) concealed hemorrhage, or (3) expanding hemorrhage.

• #35 Placental abruption differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Placental_abruption_differential_diagnosis

  Bleeding during the second half of pregnancy is usually due to either placental abruption or placenta previa. Differentiating these 2 conditions is important to the care of the patient. […] Placental abruption is an important cause of antenatal haemorrhage, Differential diagnoses to consider include: […] Subchorionic Hemorrhage: is bleeding between the amniotic sac (membranes) and the uterine wall. This can occur by the placenta disconnecting from the original site of implantation, resulting in bleeding of the chorionic membranes, the outer layer of the amniotic sac. […] Uterine rupture: This usually occurs in labour with a history of previous caesarean section or previous uterine surgery such as myomectomy, where the full-thickness disruption of the uterine muscle and overlying serosa.

• #36 Placental Abruption (Abruptio Placentae) – Women’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/women-s-health-issues/complications-of-pregnancy/placental-abruption-abruptio-placentae

  Placental abruption is the premature detachment of the placenta from the wall of the uterus at 20 weeks or more of pregnancy. […] Doctors diagnose placental abruption based on symptoms and sometimes do ultrasonography to confirm the diagnosis. […] Symptoms of placental abruption depend on the degree of detachment and the amount of blood lost (which may be massive). […] Doctors suspect and usually diagnose premature detachment of the placenta based on symptoms, such as vaginal bleeding and abdominal pain and tenderness. […] Ultrasonography may help doctors confirm the diagnosis of premature detachment and distinguish it from placenta previa, which can cause similar symptoms.

• #37 Placental Abruption Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/placental-abruption

  Placental abruption can be challenging to diagnose. Your doctor will ask questions about your symptoms, conduct a thorough physical exam, and run some tests. […] Tests include: […] If placental abruption is suspected, you’ll probably need to be in the hospital until your doctor finds out how severe it is. A placental abruption can only be confirmed by looking at the placenta after birth. […] Vaginal bleeding in the second half of pregnancy is often the result of either placental abruption or placenta previa. Placental abruption tends to result in a more sudden and intense onset of bleeding. Additionally, while the uterus is soft and relaxed in placenta previa, the uterus is firm and hard in placental abruption.

• #38 Placental Abruption Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/placental-abruption

  Placental abruption can be challenging to diagnose. Your doctor will ask questions about your symptoms, conduct a thorough physical exam, and run some tests. […] Tests include: […] If placental abruption is suspected, you’ll probably need to be in the hospital until your doctor finds out how severe it is. A placental abruption can only be confirmed by looking at the placenta after birth. […] Vaginal bleeding in the second half of pregnancy is often the result of either placental abruption or placenta previa. Placental abruption tends to result in a more sudden and intense onset of bleeding. Additionally, while the uterus is soft and relaxed in placenta previa, the uterus is firm and hard in placental abruption.

• #39 5 Placental Abruption Nursing Care Plans – Nurseslabs

  https://nurseslabs.com/placental-abruption-nursing-care-plans/

  Placental abruption (also known as abruptio placenta or the premature separation of the placenta) occurs when the placenta appears to have been implanted correctly but begins to separate suddenly, which results in bleeding. […] The primary cause of placental abruption is unknown, but certain predisposing factors are high parity, advanced maternal age, a short umbilical cord, chronic hypertensive disease, hypertension of pregnancy, direct trauma, vasoconstriction from cocaine or cigarette use, and thrombophilic conditions that lead to thrombosis formation. […] Bleeding accompanied by abdominal or low back pain is typical of a placental abruption. […] The treatment of choice, immediate cesarean birth, is performed because of the risk for maternal shock, clotting disorders, and fetal death.

• #40 Placental Abruption or Abruptio Placenta – Dugan, Babij, Tolley & Kohler

  https://www.medicalneg.com/placental-abruption-or-abruptio-placenta/

  Placental abruption, also called abruptio placenta, is a condition where the placenta prematurely separates from the uterus. It is estimated that placental abruption occurs in approximately 1 in every 120 deliveries accounts for approximately 10 to 15 percent of fetal death. […] Several conditions have been recognized as being associated with an increased risk for a placental abruption. These include maternal hypertension, advanced maternal age and a prior history of placental abruption. […] Visible vaginal bleeding, typically associated with painful abdominal or back pain, is considered to be the most obvious sign of placental abruption. […] However, in a significant number of cases, placental abruptions can result in no visible vaginal bleeding. In such cases, the blood remains “concealed” and is retained between the detached placenta and the uterus. So-called “concealed” or “occult” placental abruptions require prompt and careful diagnosis and the expeditious implementation of medical treatment to reduce both maternal and fetal risks of injury and death.

• #41 Abruptio Placentae: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/252810-overview

  If the bleeding continues, fetal and maternal distress may develop. Fetal and maternal death may occur if appropriate interventions are not undertaken. […] The severity of fetal distress correlates with the degree of placental separation. In near-complete or complete abruption, fetal death is inevitable unless an immediate cesarian delivery is performed. […] The risk of recurrence of abruptio placentae is reportedly 4-12%. If the patient has abruptio placentae in 2 consecutive pregnancies, the risk of recurrence rises to 25%. […] A study by Pariente et al indicated that women who have placental abruption are at increased long-term risk for cardiovascular mortality.

• #42 EM@3AM: Placental Abruption – emDocs

  https://www.emdocs.net/em3am-placental-abruption/

  Common risk factors: abdominal trauma, cocaine use, advanced maternal age, HTN, multiparous. […] Never perform a pelvic exam until an ultrasound is done to confirm the location of the placenta. Manipulation can cause worsening dislocation of the placenta and increased risk of further bleeding. […] Do not rely on ultrasound to rule out the condition. […] Keys in management include maternal stabilization, cardiotocographic fetal monitoring, and emergent OB consultation.

• #43 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #44 Placental abruption – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1117

  Placental abruption is the separation of the normally located placenta before delivery of the fetus. It may be concealed or overt. […] Diagnosis is made clinically. Some ultrasound features may be helpful. Other tests are, for the most part, unreliable. […] Key diagnostic factors include vaginal bleeding, abdominal pain, uterine contractions, and uterine tenderness. […] 1st investigations to order include fetal monitoring, Hb and haematocrit, coagulation studies, Kleihauer-Betke (K-B) test, and ultrasound.

• #45 Placental Abruption – Causes – Clinical Features – Management – TeachMeObGyn

  https://teachmeobgyn.com/pregnancy/medical-disorders/placental-abruption/

  Placental abruption is where a part or all of the placenta separates from the wall of the uterus prematurely. It is an important cause of antepartum haemorrhage vaginal bleeding from week 24 of gestation until delivery. […] Any woman presenting with antepartum haemorrhage should be assessed in a systematic manner. […] Placental abruption typically presents with painful vaginal bleeding (bleeding may not be visible if it is concealed). […] On examination, the uterus may be woody (tense all of the time) and painful on palpation. […] If major bleeding is suspected, resuscitate and perform investigations simultaneously. […] In women above 26 weeks gestation, a cardiotocograph (CTG) should be performed to assess fetal wellbeing. […] An ultrasound scan should be performed when patient is stable. In placental abruption, a retroplacental haematoma may be visible. […] Any woman presenting with a significant antepartum haemorrhage should be resuscitated using an ABCDE approach. Do not delay maternal resuscitation in order to determine fetal viability. […] The ongoing management of placental abruption is dependent on the health of the fetus.

• #46 Understanding placental abruption: causes, diagnosis and treatment

  https://seriousinjury.shoosmiths.com/medical-negligence/medical-negligence-guides/understanding-placental-abruption-causes-diagnosis-and-treatment

  Placental abruption is generally diagnosed when the mother displays one or more of the symptoms above. The diagnosis is confirmed by physical examination, which may include: […] Medical history and physical examination: Doctors will take a detailed medical history and perform a physical examination to check for signs of placental abruption. […] Ultrasound: An ultrasound scan helps to visualise the placenta and the extent of the separation. […] Fetal heart rate monitoring: Continuous electronic monitoring of the baby’s heart rate can identify distress. […] Blood tests: Blood tests check for anemia, clotting issues, and overall blood loss in the mother.

• #47 EM@3AM: Placental Abruption – emDocs

  https://www.emdocs.net/em3am-placental-abruption/

  Common risk factors: abdominal trauma, cocaine use, advanced maternal age, HTN, multiparous. […] Never perform a pelvic exam until an ultrasound is done to confirm the location of the placenta. Manipulation can cause worsening dislocation of the placenta and increased risk of further bleeding. […] Do not rely on ultrasound to rule out the condition. […] Keys in management include maternal stabilization, cardiotocographic fetal monitoring, and emergent OB consultation.

• #48 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  However, ultrasound’s sensitivity in visualizing placental abruption is low. […] A Kleihauer-Betke test may be ordered to detect fetal blood cells in maternal circulation. […] The onset of placental abruption is often unexpected, sudden, and intense and requires immediate treatment. […] Delivery is necessary if the collected data results in class 2 (moderate) or class 3 (severe) classification and the fetus is viable and alive. […] Placental abruption is a serious pregnancy complication and is best managed by an interprofessional team of healthcare professionals, including an obstetrician, radiologist, hematologist, obstetric nurse, and intensivist.

• #49 Placental Abruption or Abruptio Placenta – Dugan, Babij, Tolley & Kohler

  https://www.medicalneg.com/placental-abruption-or-abruptio-placenta/

  Careful and safe obstetricians typically diagnose placental abruptions by evaluating both maternal and fetal clinical signs and symptoms. It has been recognized that abdominal ultrasounds are generally unhelpful in definitively identifying placental abruptions for the purpose of diagnosis. […] A placental abruption or abruptio placenta is considered a dire obstetrical emergency, potentially placing both the life of the mother and her baby at risk. […] Accordingly, the prompt diagnosis of a placental abruption is critical to the implementation of appropriate medical interventions, which often includes emergency cesarean delivery. […] Thus, the diagnosis of placental abruption must be made as expeditiously as possible so that reasonable precautions and medical interventions can be promptly implemented to avoid the possible life threatening risks for both mother and baby.

• #50 Placental abruption | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/placental-abruption?lang=us

  Placental abruption (or abruptio placentae) refers to a premature separation of the normally implanted placenta after the 20th week of gestation and before the 3rd stage of labor. It is a potentially fatal complication of pregnancy and a significant cause of third-trimester bleeding/antepartum hemorrhage. […] Ultrasound is almost always the first (and usually the only) imaging modality used to evaluate placental abruption, but an index of suspicion should be maintained for the diagnosis since ultrasound is relatively insensitive for the diagnosis. […] MR imaging can accurately detect placental abruption and should be considered after negative US findings in the presence of late pregnancy bleeding if the diagnosis of abruption would change management. […] Given the low sensitivity for detecting placental abruption on ultrasound, if there is a high clinical suspicion, then it is likely prudent to treat based on the clinical suspicion.

• #51 Placental Abruption and Medical Malpractice

  https://www.mellinolaw.com/news/placental-abruption-and-medical-malpractice

• #52 How to Recognize Placental Abruption

  https://www.verywellhealth.com/placental-abruption-5184409

  Placental abruption is usually diagnosed based on symptoms, especially bleeding and abdominal pain. If your healthcare provider suspects a placental abruption, an ultrasound may be ordered. […] A definitive diagnosis can only be made after examination of the placenta following birth. A placenta that has abrupted will usually have an area of clotted blood. […] Bleeding during the second half of pregnancy can have other causes, like placenta previa. Your healthcare provider needs to differentiate between potential causes to identify the proper course of treatment. […] Placental abruption is diagnosed by symptoms, including vaginal bleeding. It may be treated with close monitoring or immediate delivery by vaginal birth or C-section.

• #53 Placental Abruption | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/p/placental-abruption.html

  Placental abruption can cause bleeding. […] Your healthcare provider can diagnose placental abruption based on your symptoms. These include the amount of bleeding and pain. You will likely need an ultrasound. This test will show where the bleeding is. The provider will also check on your developing baby. […] Sometimes placental abruption isn’t found until after delivery, when an area of clotted blood is found behind the placenta.

• #54 Abruptio Placentae Workup: Laboratory Studies, Ultrasonography, Nonstress Test

  https://emedicine.medscape.com/article/252810-workup

  A biophysical profile (BPP) can be used to help evaluate patients with chronic abruptions who are being managed conservatively. […] A modified BPP (nonstress test with amniotic fluid index) is sometimes used for monitoring in this situation. […] After delivery of the placenta, a retroplacental clot may be noted. Another possible finding involves extravasation of blood into the myometrium, which produces a purple discoloration of the uterine serosa. […] A study that included the data from 35,307 women and 250 cases of abruption reported abnormal pregnancy-associated plasma protein A, maternal serum alpha-fetoprotein, and inhibin-A analytes were associated with increased risk of abruption.

• #55 Bleeding in Pregnancy/Placenta Previa/Placental Abruption | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/bleeding-pregnancyplacenta-previaplacental-abruption

  Placental abruption is the premature separation of a placenta from its implantation in the uterus. […] Placental abruption occurs about once in every 100 births. It is also called abruptio placenta. […] The diagnosis of placental abruption is usually made by the symptoms, and the amount of bleeding and pain. Ultrasound may also be used to show the location of the bleeding and to check the fetus. […] Sometimes placental abruption is not diagnosed until after delivery, when an area of clotted blood is found behind the placenta.

• #56

  https://journals.lww.com/obgynsurvey/Fulltext/2010/05000/Diagnosis_of_Placental_Abruption__Relationship.6.aspx?generateEpub=Article%7Cobgynsurvey:2010:05000:00006%7C10.1097/ogx.0b013e3181e39b4d%7C

  Despite intensive investigation, it is unclear whether the diagnosis of placental abruption should be based on established clinical criteria or histopathological findings. […] The aim of the present multicenter, case-control study was to assess the concordance between clinical and histopathological diagnostic indicators of placental abruption. […] The clinical and histologic criteria for abruption were compared using data obtained from the New Jersey-Placental Abruption Study. […] Criteria for the clinical diagnosis of placental abruption included painful vaginal bleeding accompanied by nonreassuring fetal status, uterine hypertonicity, evidence of clinically significant retroplacental bleeding, or clot(s) or placental abruption diagnosed on prenatal ultrasound. […] The pathological criteria for a diagnosis of abruption included hematoma with or without recent or old infarctions, foci of villous compression, fibrin deposition, and hemosiderin-laden histiocytes in cases with older hematomas.

• #57

  https://journals.lww.com/obgynsurvey/Fulltext/2010/05000/Diagnosis_of_Placental_Abruption__Relationship.6.aspx?generateEpub=Article%7Cobgynsurvey:2010:05000:00006%7C10.1097/ogx.0b013e3181e39b4d%7C

  Of the 162 clinically diagnosed cases, only 30.2% (n = 49) were confirmed as placental abruption based on gross or histological findings, whereas the specificity for a histologic confirmation of abruption was 100%. […] The investigators conclude from these finding that there is poor concordance between the clinical and pathological diagnosis of placental abruption. […] The diagnosis of abruption should be based on clinical criteria such as evidence of retroplacental bleeding or clot(s), ultrasound visualization of abruption, or painful vaginal bleeding accompanied by either nonreassuring fetal status or uterine hypertonocity.

• #58 Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2814948/

  We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. […] The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The concordance between clinical and pathologic criteria for abruption diagnosis is poor. […] The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The most common indication leading to a clinical diagnosis of abruption was evidence of retroplacental clot(s) or bleeding (77.1%), followed by vaginal bleeding with uterine hypertonicity (27.8%) and by vaginal bleeding with nonreassuring fetal status (16.1%).

• #59 Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2814948/

  We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. […] The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The concordance between clinical and pathologic criteria for abruption diagnosis is poor. […] The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. […] The most common indication leading to a clinical diagnosis of abruption was evidence of retroplacental clot(s) or bleeding (77.1%), followed by vaginal bleeding with uterine hypertonicity (27.8%) and by vaginal bleeding with nonreassuring fetal status (16.1%).

• #60 Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2814948/

  Clinical indicators, such as nonreassuring fetal status in the presence of vaginal bleeding, as well as retroplacental clots/bleeding may be important markers for a clinical diagnosis of placental abruption. […] This study suggests that (i) the concordance between the clinical and pathological diagnosis of placental abruption is poor; (ii) clinical diagnosis for abruption should include one or more of the following: retroplacental bleeding or clot(s), sonographic visualization of abruption, or painful vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.

• #61

  https://journals.lww.com/obgynsurvey/Fulltext/2010/05000/Diagnosis_of_Placental_Abruption__Relationship.6.aspx?generateEpub=Article%7Cobgynsurvey:2010:05000:00006%7C10.1097/ogx.0b013e3181e39b4d%7C

  Despite intensive investigation, it is unclear whether the diagnosis of placental abruption should be based on established clinical criteria or histopathological findings. […] The aim of the present multicenter, case-control study was to assess the concordance between clinical and histopathological diagnostic indicators of placental abruption. […] The clinical and histologic criteria for abruption were compared using data obtained from the New Jersey-Placental Abruption Study. […] Criteria for the clinical diagnosis of placental abruption included painful vaginal bleeding accompanied by nonreassuring fetal status, uterine hypertonicity, evidence of clinically significant retroplacental bleeding, or clot(s) or placental abruption diagnosed on prenatal ultrasound. […] The pathological criteria for a diagnosis of abruption included hematoma with or without recent or old infarctions, foci of villous compression, fibrin deposition, and hemosiderin-laden histiocytes in cases with older hematomas.

• #62

  https://journals.lww.com/obgynsurvey/Fulltext/2010/05000/Diagnosis_of_Placental_Abruption__Relationship.6.aspx?generateEpub=Article%7Cobgynsurvey:2010:05000:00006%7C10.1097/ogx.0b013e3181e39b4d%7C

  Of the 162 clinically diagnosed cases, only 30.2% (n = 49) were confirmed as placental abruption based on gross or histological findings, whereas the specificity for a histologic confirmation of abruption was 100%. […] The investigators conclude from these finding that there is poor concordance between the clinical and pathological diagnosis of placental abruption. […] The diagnosis of abruption should be based on clinical criteria such as evidence of retroplacental bleeding or clot(s), ultrasound visualization of abruption, or painful vaginal bleeding accompanied by either nonreassuring fetal status or uterine hypertonocity.

• #63

  https://journals.lww.com/greenjournal/abstract/2016/05001/is_placental_abruption_still_a_clinical_diagnosis_.117.aspx

  Placental Abruption (PA) complicates 1% of pregnancies and is a leading cause of perinatal morbidity and mortality. Presentation varies widely, making the diagnosis sometimes challenging. […] The above markers did not offer additional aid in making the diagnosis of PA. Although 35% of the PAs were missed using individual clinical acumen, it appears to be one of our most accurate tools at this time.

• #64 Placental Abruption: Causes, Symptoms, & Treatment

  https://my.clevelandclinic.org/health/diseases/9435-placental-abruption

  Placental abruption is a condition during pregnancy when the placenta separates from the uterus. A healthcare provider will diagnose and treat a placental abruption based on the severity of the separation and gestational age of the fetus. […] Your healthcare provider will diagnose placental abruption with an exam and other tests. You may be admitted to the hospital depending on the severity of the abruption or you may be able to rest at home. […] There are typically three grades, or classes, of placental abruption a healthcare provider will diagnose: Grade 1: Small amount of bleeding, some uterine contractions and no signs of stress to you or the fetus. This is usually a mild or partial placental abruption, meaning only part of the placenta is detached. Grade 2: Mild to moderate amount of bleeding, some uterine contractions and possible signs of fetal distress. Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions that dont relax, abdominal pain, low blood pressure and potential fetal death. […] Once the placenta has separated from the uterus, it cant be reconnected or repaired. A healthcare provider will recommend treatment based on the severity of the abruption.

• #65 Placental abruption | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placental-abruption

  Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have pain and serious bleeding. […] If your provider thinks you are having an abruption, you may need to get checked at the hospital. Your provider can look for abruption by doing a physical exam and an ultrasound. An ultrasound can find many, but not all, abruptions. Your provider will also monitor your baby’s heartbeat. […] Treatment depends on how serious the abruption is and how far along you are in your pregnancy. Your provider may simply monitor you and your baby. But sometimes you may need to give birth right away. […] If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. […] If you have a moderate to severe abruption, you are in a medical emergency and usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

• #66 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  However, ultrasound’s sensitivity in visualizing placental abruption is low. […] A Kleihauer-Betke test may be ordered to detect fetal blood cells in maternal circulation. […] The onset of placental abruption is often unexpected, sudden, and intense and requires immediate treatment. […] Delivery is necessary if the collected data results in class 2 (moderate) or class 3 (severe) classification and the fetus is viable and alive. […] Placental abruption is a serious pregnancy complication and is best managed by an interprofessional team of healthcare professionals, including an obstetrician, radiologist, hematologist, obstetric nurse, and intensivist.

• #67 Placental Abruption – Causes – Clinical Features – Management – TeachMeObGyn

  https://teachmeobgyn.com/pregnancy/medical-disorders/placental-abruption/

  Placental abruption is where a part or all of the placenta separates from the wall of the uterus prematurely. It is an important cause of antepartum haemorrhage vaginal bleeding from week 24 of gestation until delivery. […] Any woman presenting with antepartum haemorrhage should be assessed in a systematic manner. […] Placental abruption typically presents with painful vaginal bleeding (bleeding may not be visible if it is concealed). […] On examination, the uterus may be woody (tense all of the time) and painful on palpation. […] If major bleeding is suspected, resuscitate and perform investigations simultaneously. […] In women above 26 weeks gestation, a cardiotocograph (CTG) should be performed to assess fetal wellbeing. […] An ultrasound scan should be performed when patient is stable. In placental abruption, a retroplacental haematoma may be visible. […] Any woman presenting with a significant antepartum haemorrhage should be resuscitated using an ABCDE approach. Do not delay maternal resuscitation in order to determine fetal viability. […] The ongoing management of placental abruption is dependent on the health of the fetus.

• #68 EM@3AM: Placental Abruption – emDocs

  https://www.emdocs.net/em3am-placental-abruption/

  Placental abruption is defined as the premature separation of the placenta from the uterine wall usually after 20 weeks and prior to delivery. […] Placental abruption is a clinical diagnosis and often confirmed after delivery by evaluating the placenta. […] The key in managing placental abruption is maternal stabilization, cardiotocographic fetal monitoring, and emergent OB consultation. […] Continuous maternal/fetal monitoring. […] Secure IV access with 2 large bore IVs, as these patients may be at risk for hemorrhagic shock, so they may need blood transfusions. […] Severe abruption should be managed by immediate delivery. […] Placental abruption classically presents with painful, often sudden third trimester bleeding, but you may not always see vaginal bleeding if the abruption is concealed.

• #69 Placental Abruption [+ Free Cheat Sheet] | Lecturio Nursing

  https://www.lecturio.com/nursing/free-cheat-sheet/placental-abruption/

  Placental abruption, also referred to as abruptio placentae, is a premature separation of the placenta from the uterine wall before completion of second-stage labor. […] This obstetric emergency compromises fetal oxygen supply, prompting fetal distress and possible death. Bleeding from the placental site can lead to shock, disseminated intravascular coagulation (DIC), and possible death for the client without prompt intervention. […] Ultrasound is used to identify the placental location to rule out previa; however, ultrasound has a low sensitivity for identifying acute abruption. […] Potential important nursing diagnoses related to placental abruption include: Risk for fetal injury due to the potential compromise in fetal oxygenation, Risk for maternal injury due to the possibility of significant hemorrhage, Acute pain related to uterine cramping, Deficient fluid volume related to hemorrhage, Anxiety due to the unpredictability and potential severity of the condition.

• #70 Placental Abruption [+ Free Cheat Sheet] | Lecturio Nursing

  https://www.lecturio.com/nursing/free-cheat-sheet/placental-abruption/

  The main nursing tasks when caring for a client with placental abruptions include: Close monitoring of vital signs or parent and fetus (FHR), Being prepared for rapid intervention in the case of hemorrhage (monitoring for signs of shock, bed rest, having transfusions ready), Preparing for the delivery/being prepared for emergency delivery, Pain and fluid management (establishing IV access), Emotional support and education in the very stressful and frightening situation, including discussion of potential outcomes, Continued monitoring postpartum.

• #71 Placental abruption | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placental-abruption

  Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have pain and serious bleeding. […] If your provider thinks you are having an abruption, you may need to get checked at the hospital. Your provider can look for abruption by doing a physical exam and an ultrasound. An ultrasound can find many, but not all, abruptions. Your provider will also monitor your baby’s heartbeat. […] Treatment depends on how serious the abruption is and how far along you are in your pregnancy. Your provider may simply monitor you and your baby. But sometimes you may need to give birth right away. […] If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. […] If you have a moderate to severe abruption, you are in a medical emergency and usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

• #72 Placental Abruption – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482335/

  Placental abruption is the early separation of the placenta from the lining of the uterus before the completion of the second stage of labor. […] A focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. […] Because a definitive diagnosis of placental abruption can only be made after birth when the placenta is examined, the history and physical examination are critical to the appropriate management of the maternal/fetal dyad. […] Evaluation of vital signs to detect tachycardia or hypotension, which may be indicators of a concealed hemorrhage, are taken. […] There are no laboratory tests or diagnostic procedures to diagnose placental abruption definitively. […] An ultrasound examination is useful in determining the placental location and eliminating the diagnosis of placenta previa.

• #73 Abruptio Placentae | 5-Minute Clinical Consult

  https://www.unboundmedicine.com/5minute/view/5-Minute-Clinical-Consult/816105/all/Abruptio_Placentae

  Bleeding at the decidua-placental interface. The diagnosis is typically reserved for pregnancies after 20 weeks. […] Abruption is a clinical diagnosis suggested by vaginal bleeding, abdominal pain, and contractions. Ultrasound may confirm the diagnosis but cannot exclude it. […] Placental abruption is a clinical diagnosis.

• #74 Treatment of placental abruption following blunt abdominal trauma: a case report

  https://jtraumainj.org/journal/view.php?number=1331

  Trauma during pregnancy poses a potentially tragic risk to both the fetus and mother, making its management particularly challenging. […] Ultrasonography revealed no clear evidence of placental abruption. […] Placental abruption is a severe traumatic event that can occur during pregnancy. It occurs in 1% of all pregnancies and is one of the most frequent causes of perinatal and maternal morbidity. […] Although ultrasonography is widely used in the initial evaluation of the fetus, its sensitivity for detecting placental abruption is only 24%, and false-negative findings of 50% have been reported. […] Placental abruption is clinically diagnosed and should be suspected when a patient presents with vaginal bleeding or abdominal pain after trauma. […] The optimal length of fetal monitoring following trauma is not clear, though the EAST guidelines recommend a minimum of 6 hours of cardiotocographic monitoring for pregnant women at 20 weeks of gestation. […] Even with minor trauma, abruption can occur, and it is important to maintain a high level of suspicion to detect the abruption.

• #75 How does Placental Abruption Relate to HIE? | Birth Injury FAQ

  https://www.abclawcenters.com/frequently-asked-questions/placental-abruption-and-hie/

  A placental abruption is when the placenta separates too early, while the baby is not yet delivered. A placental abruption is an obstetrical emergency because it jeopardizes the health of both mother and baby. […] Health care systems must recognize the signs and symptoms of placental abruption and deliver in time before a baby suffers HIE. Signs and symptoms may include: abdominal pain, bleeding, too many contractions, and abnormalities on the fetal heart monitor and signs of fetal distress. Some abruptions are hidden or concealed and show no bleeding at all. […] Diagnosis of placental abruption is based on observation of signs and symptoms. The health care system should pay close attention to the mother and baby, especially if the mother has known risk factors for placental abruption.

• #76 Placental abruption – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458

  Placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. […] Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. […] Seek emergency care if you have signs or symptoms of placental abruption.

• #77 Reddit – The heart of the internet

  https://www.reddit.com/r/pregnant/comments/10bse82/placental_abruption_my_story/

  I had a placental abruption which resulted in hemorrhaging and preterm delivery about 2 weeks ago. […] In short – I was 2 cm dilated, having active labor contractions, and my placenta had partially detached causing hemorrhaging and fetal distress. […] Symptoms to watch for, which are admittedly nuanced given how you feel in the third trimester: Lower back pain above and beyond what you have experienced as baseline, extended periods of cramping and BH/actual contractions, fatigue/weakness that feels different than normal pregnancy fatigue. When in doubt, get checked out. […] If I hadnt bled I probably wouldnt have gone into the hospital and this would be a different story. Please go in if youre having any doubts.

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