Placental abruption is a major complication of pregnancy particularly in primigravidae in which there is a detachment of the placenta from the point of implantation (the uterine wall). Also called abruptio placentae, it is mainly characterized by uterine bleeding usually occurring after the 20th week of gestation. Nonetheless, the vaginal bleeding that accompanies placental abruption in majority of cases is not always overt, hence, making early detection difficult. The condition raises major concern on an impending fetal and maternal complication and so, may be a signal for subsequent fetal and/or maternal mortality if not properly managed. It occurs in about 2-3% of pregnancy especially in nulliparous and multiparous mothers. The etiology of abruptio placentae is unknown, but different researchers have suggested failure of fetal placental trophoblastic invasion of maternal decidual lining.
Apart from this, conditions like preeclampsia, septicemia, trauma, drugs (like tobacco and cocaine), retroplacental fibromyoma, and previous history of placental abruption, all increase the chances of placental abruption occurrence. Affected gravid women usually may present with vaginal bleeding, abdominal or back pain, with fetal distress and a terminal premature delivery. Mothers may suffer disseminated intravascular coagulation, multiple organ failure and even circulatory stasis due to hypovolemia resulting from severe blood loss. As for the fetus, fetal distress is likely to occur, with fetal lung immaturity, irreparable brain damage and fetal death.
Whenever placental abruption is suspected ultrasonographic examination of the uterine wall should be indicated. Treatment though depends on the amount of blood loss and the status of the fetus, should be a function of considering the maternal risk of continuing pregnancy and fetal chances of extrauterine existence. The options might range from transfusion of the mother to induction of preterm delivery. Sufficient bed rest, balanced diet, folic acids supplementation have been found to be of great importance in controlling the incidence of placental abruption.
