Chapter 217 Placental Abruption
INTRODUCTION
Description: Placental abruption is premature separation of an otherwise normally implanted placenta before delivery of the fetus.
Prevalence: One in 185 to 290 deliveries; sufficient to result in fetal death, 1 in 1600 deliveries (approximately 10% of third-trimester fetal demise).
ETIOLOGY AND PATHOGENESIS
Causes: Pregnancy-induced hypertension (most common), trauma to the abdomen, decompression of an overdistended uterus (loss of amniotic fluid, delivery of a twin), cocaine use.
Risk Factors: Pregnancy-induced hypertension (most common). Prior abruption: 15% chance if one prior episode, 20% to 25% for two or more prior events. Others: smoking >1 pack/day (2-fold increased risk), multiparity, alcohol abuse, cocaine use, polyhydramnios, maternal hypertension, premature rupture of the membranes, external trauma, uterine leiomyomata, increased age or parity, and multiple gestation.
DIAGNOSTIC APPROACH
Differential Diagnosis
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