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Placental abruption: Clinical features and diagnosis

Cande V Ananth, PhD, MPH
Wendy L Kinzler, MD
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Placental abruption (also referred to as abruptio placentae) is bleeding at the decidual-placental interface that causes partial or complete placental detachment prior to delivery of the fetus. The diagnosis is typically reserved for pregnancies over 20 weeks of gestation. The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions, uterine tenderness, and a nonreassuring fetal heart rate (FHR) pattern.

Abruption is a significant cause of maternal and perinatal morbidity, and perinatal mortality. The perinatal mortality rate is approximately 20-fold higher in comparison to pregnancies without abruption (12 percent versus 0.6 percent, respectively) [1]. The majority of perinatal deaths (up to 77 percent) occur in utero; deaths in the postnatal period are primarily related to preterm delivery [1-4]. However, perinatal mortality associated with abruption appears to be decreasing [1].


Placental abruption complicates approximately 1 percent of pregnancies [5,6], with two-thirds classified as severe due to accompanying maternal, fetal, and neonatal morbidity [7]. The incidence appears to be increasing in the United States, Canada, and several Nordic countries [5], possibly due to increases in the prevalence of risk factors for the disorder and/or to changes in case ascertainment [8,9].

In one review, 40 to 60 percent of abruptions occurred before 37 weeks of gestation and 14 percent occurred before 32 weeks [10]. However, gestational age-specific incidence rates vary considerably depending on the etiology [11,12].


The immediate cause of the premature placental separation is rupture of maternal vessels in the decidua basalis, where it interfaces with the anchoring villi of the placenta. Rarely, the bleeding originates from the fetal-placental vessels. The accumulating blood splits the decidua, separating a thin layer of decidua with its placental attachment from the uterus. The bleed may be small and self-limited, or may continue to dissect through the placental-decidual interface, leading to complete or near complete placental separation. The detached portion of the placenta is unable to exchange gases and nutrients; when the remaining fetoplacental unit is unable to compensate for this loss of function, the fetus becomes compromised.


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Literature review current through: Dec 2016. | This topic last updated: Wed Jan 04 00:00:00 GMT+00:00 2017.
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