Placental abruption pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun M.D., PhD.

Pathophysiology

Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption.

Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death.

Lasting Effects

On the Mother

  • A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
  • The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract.
  • The mother may have problems with blood clotting for a few days.
  • If the mother's blood does not clot (particularly during a caesarean section) and too many transfusions could put the mother into disseminated intravascular coagulation (DIC), the doctor may consider a hysterectomy.
  • A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland.
  • In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported.

On the Baby

  • If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery.
  • The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding.
  • If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth.
  • The newborn may have low blood pressure or a low blood count.
  • If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.

References



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