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Description: Placental abruption is the premature separation of an otherwise normally implanted placenta before the delivery of the fetus. The term is generally applied only to 20-week or later gestations.
Prevalence: 1/185–290 deliveries; sufficient to result in fetal death, 2–10/1000 deliveries (approximately 10% of third-trimester fetal demise).
Predominant Age: Reproductive age.
Genetics: No genetic pattern.
Causes: Pregnancy-induced hypertension (most common), trauma to the abdomen, decompression of an overdistended uterus (loss of amniotic fluid, delivery of a twin), cocaine use. It is thought that abnormalities in the early development of the spiral arteries lead to decidual necrosis, placental inflammation, and infarction, resulting in vascular disruption and bleeding.
Risk Factors: Pregnancy-induced hypertension (most common, 5-fold increased risk over those with normal blood pressure). Prior abruption: 15% chance if one prior episode, 20%–25% for two or more prior events. Others: smoking more than 1 pack/day (2.5-fold increased risk; risk increases by 40% for each pack/day smoked), multiparity, alcohol abuse, cocaine use, polyhydramnios, maternal hypertension (5-fold increased risk), premature rupture of the membranes, external trauma, uterine leiomyomata or anomalies, increased age or parity, and multiple gestation.
Highly variable
Vaginal bleeding (not universal; approximately 80%)
Abdominal, back, or uterine pain (65%)
Fetal bradycardia or late decelerations (60%)
Uterine irritability, tachysystole, tetany, elevated baseline intrauterine pressure (20%–40%, thrombin is a strong uterotonic)
Maternal hypotension or signs of volume loss (postural hypotension, shock)
Fetal demise
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