eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Abruptio Placentae: Follow-up

Author: Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Contributor Information and Disclosures

Updated: Dec 12, 2008

Follow-up

Further Inpatient Care

  • Labor, delivery, and postpartum care
  • Further management of the complications of abruptio placentae

Deterrence/Prevention

  • Treat maternal hypertension.
  • Prevent maternal trauma/domestic violence.
  • Prevent smoking and substance abuse.
  • Diagnose placental abruption at an early stage in high-risk groups (eg, maternal hypertension, maternal trauma, association with domestic violence, smoking habit, substance abuse, advanced maternal age, premature ruptured membranes, uterine fibromyomas, amniocentesis).

Complications

  • Maternal complications
    • Hemorrhagic shock
    • Coagulopathy/DIC
    • Uterine rupture
    • Renal failure
    • Ischemic necrosis of distal organs (eg, hepatic, adrenal, pituitary)
  • Fetal complications
    • Hypoxia
    • Anemia
    • Growth retardation
    • CNS anomalies
    • Fetal death

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Some patients may not have the classic presentation of abruption, especially with posterior implantation.
  • Consider a diagnosis of placental abruption for every patient in premature labor. Carefully monitor patients to exclude or establish this diagnosis.
  • Absence of vaginal bleeding does not exclude placental abruption.
  • DIC/coagulopathy may occur even if clotting factors initially are within reference ranges. Continue to monitor clotting factors.
  • Normal ultrasound findings do not exclude placental abruption.
 


More on Abruptio Placentae

Overview: Abruptio Placentae
Differential Diagnoses & Workup: Abruptio Placentae
Treatment & Medication: Abruptio Placentae
Follow-up: Abruptio Placentae
References
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References

  1. Ananth CV, Oyelese Y, Yeo L, et al. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynecol. Jan 2005;192(1):191-8. [Medline].

  2. Broers T, King WD, Arbuckle TE, Liu S. The occurrence of abruptio placentae in Canada: 1990 to 1997. Chronic Dis Can. 2004;25(2):16-20. [Medline].

  3. Dahmus MA, Sibai BM. Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress?. Am J Obstet Gynecol. Oct 1993;169(4):1054-9. [Medline].

  4. Green JR. Placental abnormalities: Placenta previa and abruptio placentae. In: Creasy RK, Resnik R, eds. Maternal Fetal Medicine. Philadelphia, Pa: WB Saunders; 1984:539.

  5. Lowe TW, Cunningham FG. Placental abruption. Clin Obstet Gynecol. Sep 1990;33(3):406-13. [Medline].

  6. Morgan MA, Berkowitz KM, Thomas SJ, et al. Abruptio placentae: perinatal outcome in normotensive and hypertensive patients. Am J Obstet Gynecol. Jun 1994;170(6):1595-9. [Medline].

  7. Nolan TE, Smith RP, Devoe LD. A rapid test for abruptio placentae: evaluation of a D-dimer latex agglutination slide test. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):265-8; discussion 268-9. [Medline].

  8. Plunkett J, Borecki I, Morgan T, et al. Population-based estimate of sibling risk for preterm birth, preterm premature rupture of membranes, placental abruption and pre-eclampsia. BMC Genet. Jul 8 2008;9:44. [Medline].

  9. Pritchard JA, Mason R, Corley M, Pritchard S. Genesis of severe placental abruption. Am J Obstet Gynecol. Sep 1 1970;108(1):22-7. [Medline].

  10. Signore C, Mills JL, Qian C, et al. Circulating angiogenic factors and placental abruption. Obstet Gynecol. Aug 2006;108(2):338-44. [Medline].

  11. Steer PL, Finley BE, Blumenthal LA. Abruptio placentae and disseminated intravascular coagulation: use of thrombelastography and sonoclot analysis. Int J Obstet Anesth. 1994;3(4):229-233. [Medline].

  12. Steinborn A, Seidl C, Sayehli C, et al. Anti-fetal immune response mechanisms may be involved in the pathogenesis of placental abruption. Clin Immunol. Jan 2004;110(1):45-54. [Medline].

  13. Tikkanen M, Nuutila M, Hiilesmaa V. Clinical presentation and risk factors of placental abruption. Acta Obstet Gynecol Scand. 2006;85(6):700-5. [Medline].

  14. Toivonen S, Heinonen S, Anttila M, et al. Obstetric prognosis after placental abruption. Fetal Diagn Ther. Jul-Aug 2004;19(4):336-41. [Medline].

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Further Reading

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Keywords

abruptio placentae, placental abruption, cesarean delivery, cesarean birth, cesarean section, c-section, Couvelaire uterus, separation of the placenta, vaginal bleeding, abdominal pain, back pain, uterine tenderness, fetal distress, abnormal uterine contractions, idiopathic premature labor, fetal death

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Contributor Information and Disclosures

Author

Slava V Gaufberg, MD, Assistant Professor of Medicine, Harvard Medical School; Director of Transitional Residency Training Program, Cambridge Health Alliance
Slava V Gaufberg, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Roy Alson, MD, PhD, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare
Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, North Carolina Medical Society, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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