Obstetrics & Gynecology
Placental Abruption
태반조기박리
Premature separation of normally implanted placenta from uterine wall before delivery
- How common
- 0.5–1% of pregnancies
- Typical age
- Mostly late pregnancy
What is it?
Decidual artery rupture → retroplacental hematoma → separation from uterine wall → bleeding, uterine tetany, fetal hypoxia.
Commonly affected: Placental-uterine interface, fetal oxygenation, coagulation
How it develops
- Decidual vessel ruptureRisk: HTN, trauma, cocaine, prior abruption
- Retroplacental hematomaBlood accumulates behind placenta
- Separation extendsExpanding separation reduces fetal oxygenation
- Uterine tetany & DICTetanic uterine contraction; consumptive coagulopathy (DIC)
Symptoms
- Severe abdominal painSudden, continuous
- Tetanic/woody uterusHard, tender, no relaxation
- Fetal distressLate decels, tachycardia, demise
- ShockBlood loss often underestimated
- Dark vaginal bleeding20% concealed (no external bleed)
How it is examined
- Continuous EFMMandatory continuous monitoring
- TAUSRetroplacental hematoma (low sensitivity; clinical diagnosis)
- Coagulation/labsCBC, PT/PTT, fibrinogen, D-dimer, Kleihauer-Betke
Imaging
X-ray not used.
- Not applicable
US adjunct only. May show retroplacental hematoma but negative US does not exclude.
- Retroplacental hematoma
- Thickened placenta
- May be negative
Non-surgical care
- Rapid resuscitationTwo large-bore IVs, O₂, left lateral position
- Fluid/blood productsCrystalloid + PRBC, FFP, platelets (watch DIC)
- Fetal monitoringContinuous EFM; deliver if non-reassuring
- Antenatal corticosteroidsBetamethasone (24–34 wk if stable)
- Anti-D immunoglobulinRh-negative mothers; dose per Kleihauer result
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Non-reassuring fetus, maternal instability, massive bleeding
Procedures that may be discussed
- Emergency cesarean
- Vaginal delivery if stable and at term
- Hysterectomy if uncontrolled DIC
Outlook
Mild prognosis good; severe abruption maternal mortality ~1%, fetal mortality ~12%, recurrence 5–17%.