Obstetrics

Placental Abruption

Premature separation of a normally sited placenta: decidual bleeding strips the placenta off the uterine wall, so pain, hypertonus, fetal hypoxia and coagulopathy appear with almost no visible blood.

Definition

Placental abruption is premature separation of a normally sited placenta before birth, from 24+0 weeks of pregnancy onwards. Bleeding may be revealed at the introitus, wholly concealed behind the placenta or within the myometrium, or both. It is a clinical diagnosis: there is no sensitive or reliable diagnostic test.

First principles

Abruption is a clinical diagnosis and the scan usually misses it

Ultrasound has a sensitivity of only 24% for retroplacental clot, so it fails to detect three-quarters of abruptions. Specificity is 96%, so a positive scan is close to diagnostic. Scan to establish placental site and to confirm fetal heart activity, never to rule abruption out.

You’ve reached the end of the preview

The rest of this extended textbook page is part of full access. Create a free account to read the sample topics in full and try sample questions, then upgrade to unlock every high-yield and extended page, plus the complete question bank.

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.