abruption


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Related to abruption: placenta previa

ab·rup·tion

(ab-rŭp'shŭn),
A tearing away, separation, or detachment.

abruption

Etymology: L, ab, away from, rumpere, rupture
a sudden breaking off or tearing apart.

abruptio placentae

The premature separation of the placenta from its site of implantation in the endometrium before the delivery of the foetus, commonly known as placental abruption. Some degree of AP occurs in 1:85 deliveries; severe AP with total separation of the placenta is an obstetric emergency seen in 1 in 500–750 deliveries, often accompanied by foetal death.

Clinical findings
Abdominal and/or back pain; irritable, tender or hypertonic uterus; vaginal bleeding (seen in most); 30% are asymptomatic.
 
Predisposing factors
Pre-eclampsia, eclampsia, chronic hypertension, diabetes, chronic renal disease; mechanical causes are rare (1–5%) and include transabdominal trauma, sudden decompression (as occurs in the delivery of a 1st twin or rupture of membranes in hydramnios) or traction of a short placenta.

Pathophysiology, proposed mechanisms
Local vascular injury of the decidua basalis with bleeding and haematoma formation, which causes shearing of adjacent denuded vessels, exacerbating the bleeding and haematoma; abrupt increased in uterine venous pressure transmitted to intervillous space, resulting in venous bed engorgement and separation of part or the entire placenta.

Management
Expectant therapy if foetus is immature and bleeding limited, treat shock if present; vaginal delivery if possible, or else C-section.

Complications
DIC, acute cor pulmonale, renal cortical and tubular necrosis, uterine apoplexy, transfusion hepatitis.

Definable, direct causes that trigger placenta abruptio
Rare (1 to 5%) mechanical factors such as abdominal trauma (for example, from an automobile accident or fall), sudden loss in uterine volume as occurs with rapid loss of amniotic fluid or the delivery of a first twin, or an abnormally short umbilical cord (usually only a problem at the time of delivery). Predisposing factors include the following risk factors: a past medical history of placenta abruptio (after 1 prior episode there is a 10 to 17% recurrence; after 2 prior episodes the incidence of recurrence exceeds 20%); hypertension during pregnancy is associated with up to 18% incidence (however, approximately 50% of placenta abruptio cases severe enough to cause foetal death are associated with hypertension); increased maternal age; increased number of prior deliveries; increased uterine distention (as may occur with multiple pregnancies or abnormally large volume of amniotic fluid); diabetes mellitus in the pregnant woman; cigarette smoking; and drinking alcohol during pregnancy (> 14 drinks per week). The incidence of placenta abruptio, including any amount of placental separation prior to delivery, is about 1 out of 77–89 deliveries; however, the severe form (resulting in foetal death) occurs only in about 1 out of 500–750 deliveries.

ab·rup·tion

(ab-rŭp'shŭn)
A breaking away.
[L. abruptio, fr. abrumpo, to break off]

abruption

A tearing away or separation.

ab·rup·tion

(ab-rŭp'shŭn)
Separation or detachment.
[L. abruptio, Fr. abrumpo, to break off]
References in periodicals archive ?
In abruption placenta group, Couvelaire uterus was seen in 2 (3.
No statistically significant differences were found in any other comparisons, such as the occurrence of gestational diabetes mellitus, hypertensive disorders of pregnancy, placenta abruption, placenta previa, fetal distress/anemia, preterm birth, cesarean section, and birth weight.
The study was conducted on 223 pregnant women who presented to the hospital with diagnosis of placental abruption including those undergoing treatment and those that have been treated and sent to the ward for further management were studied.
4,20] This study showed that in overt hypothyroidism woman 50% (1/2) had IUD, 100% (2/2) developed preeclampsia, 100% (2/2) had preterm labour, 50% (1/2) had abruption.
The RII was largest for placental abruption, followed by "other causes", while the SII was greatest for "other causes", followed by placental abruption and unspecified causes.
Tracy added: "Chloe and I were lucky enough to be in the right place at the time of my abruption, otherwise I would not be here to tell my story and neither would my gorgeous princess.
An analysis of Angelica Swartout's computer showed that she began researching placental abruption more than two months before the alleged infanticide, Crolly testified.
The placenta gives oxygen and nutrients to the baby, so it is vital it remains intact and a bleed can be an early sign of an abruption, which means the it is coming away.
1) At Tygerberg Academic Hospital (TBH), a tertiary referral hospital in Cape Town, perinatal mortality data from July 2006 to June 2007 demonstrated that placental abruption was the direct cause of 25.
Pregnant women with antibodies that can indicate early thyroid disease are three times as likely to experience placental abruption (separation) during labor, researchers at the University of Texas in Dallas have found.
Celinna lost Tischaurn after suffering a placental abruption, where the placenta becomes detached from the uterus, and has now launched legal action against the hospital with Birmingham law firm, Irwin Mitchell.
Gigris had performed a cerciage procedure prior to November 18, 2004, the placental abruption would nevertheless have occurred, and Dr.