Abruptio Placentae
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Daniel Martingano
A17-year-old woman, gravida 1, para 0, at 39 weeks gestational age with an uncomplicated prenatal course presented to the labor and delivery department in active labor. Cervical examination revealed dilation of 6 cm, 80% effacement, and −2 station. The patient was admitted and given epidural anesthesia. Six hours later, cervical examination revealed full-dilation uterine contractions at least 5 minutes apart, adequate to facilitate labor progress. Profuse vaginal bleeding, hypertonic uterine contractions, and variable decelerations on fetal heart tracing were noted. Soon after, the fetus was successfully delivered. The newborn had APGAR scores of 7 and 8 at 1 and 5 minutes, respectively. Maternal fibrinogen was 215 mg/dL after delivery. Examination of the placenta showed that hemorrhage into the decidua basalis caused partial separation of the placenta from the uterus (image, arrow) during the active phase of labor, which, along with clinical findings, demonstrated a class 2 abruptio placentae.
Abruptio placentae refers to placental detachment before delivery of the fetus caused by bleeding at the decidual placental interface.1 The primary clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions and a nonreassuring fetal heart tracing.2 Placental abruption can involve complete separation of the placenta from the uterine wall, which commonly leads to fetal death, or partial separation, which confers a more benign prognosis.2,3
References
1. Atkinson AL , Santolaya-ForgasJ, BlitzerDN, et al. Risk factors for perinatal mortality in patients admitted to the hospital with the diagnosis of placental abruption. J Matern Fetal Neonatal Med. 2015;28(5):594-597. doi:10.3109/14767058.2014.927427Search in Google Scholar PubMed
2. Tikkanen M . Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140-149. doi:10.1111/j.1600-0412.2010.01030.xSearch in Google Scholar PubMed
3. Gelaye B , SumnerSJ, McRitchieS, et al.. Maternal early pregnancy serum metabolomics profile and abnormal vaginal bleeding as predictors of placental abruption: a prospective study. PLoS One. 2016;11(6):e0156755. doi:10.1371/journal.pone.0156755Search in Google Scholar PubMed PubMed Central
© 2017 American Osteopathic Association
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Articles in the same Issue
- LETTERS TO THE EDITOR
- Evaluation of Renal Calculi Passage While Riding a Roller Coaster
- CORRECTION
- Correction
- AOA COMMUNICATION
- Official Call: 2017 Annual Business Meeting of the American Osteopathic Association (Reprint)
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
- ORIGINAL CONTRIBUTION
- Emergency Health Care Professionals’ Understanding of the Costs of Care in the Emergency Department
- BRIEF REPORT
- Effects of Osteopathic Manipulative Therapy on Pain and Mood Disorders in Patients With High-Frequency Migraine
- REVIEW
- One Health: Children, Waterfowl, and Lead Exposure in Northwestern Nigeria
- Bridging the Gap: An Osteopathic Primary Care–Centered Approach to Duchenne Muscular Dystrophy
- MEDICAL EDUCATION
- Osteopathic Medical Students Entering Family Medicine and Attitudes Regarding Osteopathic Manipulative Treatment: Preliminary Findings of Differences by Sex
- CASE REPORT
- Therapeutic Hypothermia to Treat a Newborn With Perinatal Hypoxic-Ischemic Encephalopathy
- Use of the Fascial Distortion Model to Evaluate a Limp in a Child
- CLINICAL IMAGES
- Asynchronous Bilateral Ovarian Torsion
- Abruptio Placentae
