abruption

Abruption, in obstetric terms commonly referred to as placental abruption or abruptio placentae, is the premature separation of a normally implanted placenta from the uterine wall before delivery. It typically occurs after 20 weeks of gestation and can lead to vaginal bleeding, abdominal pain, and fetal distress. The condition ranges in severity from minor separations with little bleeding to massive bleeding with sudden maternal and fetal compromise.

Signs and symptoms often include vaginal bleeding of varying amounts, sudden or gradual onset of abdominal or back pain, uterine tenderness, and frequent contractions. In some cases bleeding is concealed and only signs of fetal distress or a rigid, tender uterus appear. Maternal shock can occur with significant blood loss, and disseminated intravascular coagulation may develop in severe cases.

Causes and risk factors are multifactorial. Hypertension, preeclampsia, trauma, smoking, cocaine or other illicit drug use, advanced maternal age, prior placental abruption, and certain clotting disorders increase risk. The exact mechanism involves disruption of placental attachment and hemorrhage into the decidua, potentially compromising both mother and fetus.

Diagnosis relies on clinical presentation and maternal-fetal monitoring. Ultrasound can help identify placental position and bleeding but may miss abruptions; imaging is not definitive. Laboratory tests assess anemia and coagulation status, while continuous fetal monitoring evaluates distress.

Management depends on severity and gestational age. Hemodynamically unstable patients require resuscitation and urgent delivery, often by cesarean section. Stable cases may be managed expectantly with close monitoring, balance of maternal-fetal status, and timely delivery if deterioration occurs or fetal maturity is reached.

Prognosis varies with severity; severe abruption carries higher risks of maternal hemorrhage, DIC, and fetal mortality. Prevention focuses on mitigating risk factors such as hypertension, smoking cessation, and avoidance of illicit drugs.