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Placental Abruption
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Placental Abruption
Placental Abruption
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1
Question
What is placental abruption?
Answer
Placental abruption is the detachment of the placenta from the uterine wall before delivery.
2
Question
What is the origin of blood in a retroplacental hematoma in non-traumatic placental abruption?
Answer
Most of the blood in a retroplacental hematoma in non-traumatic placental abruption is of maternal origin.
3
Question
What causes hemorrhage in placental abruption?
Answer
Hemorrhage in placental abruption is due to separation within the maternal decidua.
4
Question
How often is fetal-maternal hemorrhage documented in non-traumatic placental abruption?
Answer
In non-traumatic placental abruption, fetal-maternal hemorrhage was documented in only 20% of cases.
5
Question
What changes can placental abruption create on the maternal surface of a newly expelled placenta?
Answer
A placental abruption can create a circumscribed depression on the maternal surface of a newly expelled placenta.
6
Question
Describe the appearance of the depressions created by placental abruption.
Answer
These depressions are typically a few centimeters in diameter and covered in dark, clotted blood.
7
Question
Can the age of a retroplacental clot be accurately determined?
Answer
It is not possible to determine with accuracy the time of evolution of a retroplacental clot.
8
Question
What does the presence of a dark, large clot in Figure 43-2 indicate about the abruption?
Answer
A dark, large clot is well-formed in the example shown in Figure 43-2, indicating the abruption happened several hours prior.
9
Question
When is the severity of placental abruption considered grave?
Answer
Severity of placental abruption is considered grave when the fetus dies.
10
Question
Are maternal and fetal complications still serious even if the fetus is alive?
Answer
Maternal complications and fetal complications are usually grave even with a living fetus.
11
Question
What are the maternal sequelae that define grave placental abruption?
Answer
Maternal sequelae include disseminated intravascular coagulation (DIC), shock, transfusion, hysterectomy, renal failure, or death.
12
Question
What are the fetal and neonatal complications that define grave placental abruption?
Answer
Fetal complications include fetal distress, growth restriction, or death; neonatal outcomes include death, premature birth, or growth restriction.
13
Question
What type of trauma can cause placental abruption?
Answer
External trauma, such as motor vehicle accidents or severe assaults, can lead to placental abruption.
14
Question
Can placental abruption result from relatively minor trauma?
Answer
Placental abruption can occur due to relatively minor trauma.
15
Question
In what cases of placental abruption is fetal-maternal hemorrhage more common?
Answer
Fetal-maternal hemorrhage is more common with trauma involving tears or "fractures" of the placenta.
16
Question
What is the most important indicator of placental abruption following blunt abdominal trauma?
Answer
Following blunt abdominal trauma, uterine contractions are the most important indicator of placental abruption.
17
Question
When is placental abruption considered chronic?
Answer
When placental abruption does not result in delivery, it is considered chronic.
18
Question
When can chronic abruption begin?
Answer
Some cases of chronic abruption begin in the early stages of pregnancy.
19
Question
What maternal serum markers have been linked with subsequent abruption?
Answer
Elevated maternal serum markers of aneuploidy have been linked with subsequent abruption.
20
Question
What correlation has been found between bleeding and placental abruption?
Answer
First and second trimester bleeding has been correlated with placental abruption in the third trimester.
21
Question
What is the name for chronic abruption with oligohydramnios?
Answer
Chronic abruption and oligohydramnios is called the chronic abruption-oligohydramnios sequence (CAOS).
22
Question
What serum levels can indicate chronic abruption?
Answer
Abnormally elevated maternal serum alpha-fetoprotein (MSAFP) or placenta-specific RNA levels can indicate chronic abruption.
23
Question
What is the average incidence of placental abruption?
Answer
The reported incidence of placental abruption averages 0.5% or 1 case in 200 deliveries.
24
Question
Which demographic group is experiencing a rise in placental abruption in the United States?
Answer
The incidence of placental abruption has increased in the United States, primarily among Black women.
25
Question
What factor may partially explain the increased incidence of placental abruption?
Answer
Conservative treatment of early-onset preeclampsia may partially explain the increased incidence of placental abruption.
26
Question
What is the trend regarding the incidence of placental abruption causing fetal death?
Answer
The incidence of placental abruption sufficient to cause fetal death has decreased.
27
Question
What role does gestational age play in placental abruption outcomes?
Answer
Gestational age determines perinatal outcomes, and the rate of placental abruption is highest in the third trimester.
28
Question
What factors increase perinatal mortality and morbidity with placental abruption?
Answer
Perinatal mortality and morbidity are more common with premature abruption and concomitant preeclampsia.
29
Question
What fetal condition is associated with placental abruption?
Answer
Significant fetal congenital anomalies have a greater connection with placental abruption.
30
Question
What is the current status of placental abruption as a cause of fetal death?
Answer
Though fetal death rates have decreased, placental abruption remains a notable cause of fetal death.