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Placental abruption and placenta praevia

  • Clinical Review
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European Clinics in Obstetrics and Gynaecology

Abstract

Antepartum haemorrhage is defined as bleeding from the genital tract from 24 weeks of gestation onwards. The incidence is around 2–5% of all pregnancies progressing beyond 24 weeks. Placenta praevia and placental abruption are of great clinical importance as causes of antepartum haemorrhage. Placenta praevia occurs when the placenta is totally or partly inserted in the lower uterine segment. The aetiology of placenta praevia may merely represent an accident of nature but is associated with advanced maternal age, multiparity and previous uterine damage such as in a previous caesarean section. Usually, the initial bleed is painless and mild, but it may be severe. Screening and diagnosis are normally by ultrasound. A dilemma exists as to whether hospitalisation should be offered to women with an asymptomatic placenta praevia. Caesarean section is the recommended mode of delivery for major placenta praevia. Haemorrhage arising from premature separation of a normally situated placenta is known as abruptio placentae. Risk factors include placental abruption in a previous pregnancy, pre-eclampsia, cigarette smoking, and trauma. The patient typically develops pain over the uterus, and this may not be associated with apparent bleeding at first. The diagnosis is mainly clinical and confirmed by the demonstration of a retroplacental clot after delivery. In the obvious case of abruption, early delivery is of crucial importance. If the baby is still alive and the gestation compatible with survival upon delivery, it is recommended that urgent caesarean section should be performed. However, if the fetus is dead, one should expedite vaginal delivery. Complications of antepartum haemorrhage include maternal shock, especially due to the increased risk of postpartum bleeding. There is a greater risk of premature delivery, fetal hypoxia and sudden fetal death.

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References

  1. Rigby E (1775) An essay on the uterine haemorrhage which precedes the delivery of the full grown fetus, 6th edn. Burkes & Kinnebrook, London

    Google Scholar 

  2. Dunn PM (2000) Dr Edward Rigby of Norwich (1747–1821) and antepartum haemorrhage. Arch Dis Child Fetal Neonatal Ed 82:F169–F170

    Article  CAS  PubMed  Google Scholar 

  3. Stirrat GM (1997) Aids to obstetrics and gynaecology for MRCOG, 4th edn. Churchill Livingstone, Edinburgh

    Google Scholar 

  4. EPICure Study Steering Group (1997) Survival and morbidity of infants born at the limit of viability. Proc R Coll Paediatr Child Health Ann Meeting 1:31

    Google Scholar 

  5. Royal College of Obstetricians and Gynaecologists (2005) Placenta praevia and placenta praevia accreta: diagnosis and management (Guideline No. 27). RCOG, London

    Google Scholar 

  6. Chamberlain G, Steer P (1999) ABC of labour care: obstetric emergencies. BMJ 318:1342–1345

    CAS  PubMed  Google Scholar 

  7. Neilson JP (1999) Antepartum haemorrhage. In: Edmonds DK (ed) Dewhurst’s textbook of obstetrics and gynaecology for postgraduates. Blackwell Science, Oxford, pp 134–144

    Google Scholar 

  8. Moses S (2006) Placental abruption (abruptio placentae). In: The family practice notebook. Accessed at: http://www.fpnotebook.com/OB13.htm on 01.07.2006.

  9. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC (1997) William’s obstetrics, 20th edn. Appleton & Lange, Stamford, CT

    Google Scholar 

  10. Enkin M, Keirse MJ, Renfrew M, Neilson J (1995) A guide to effective care in pregnancy and childbirth, 2nd edn. Oxford University Press, New York

    Google Scholar 

  11. Arulkumaran S, Symonds IM, Fowlie A (2004) Oxford handbook of obstetrics and gynaecology. Oxford University Press, Oxford

    Google Scholar 

  12. Confidential enquiry into maternal and child health (CEMACH 2004) (2004) Why mothers die 2000–2002. RCOG, London

  13. Harrison KA, Rossiter CE (1985) Maternal mortality. BJOG 5(Suppl):100–115

    Google Scholar 

  14. Neilson JP (1994) Perinatal loss and appropriate fetal surveillance. In: Van Geijn HP, Copray FJ (eds) A critical appraisal of fetal surveillance. Elsevier Science, Amsterdam, pp 16–24

    Google Scholar 

  15. Palmer L, Blair E, Petterson B, Burton P (1995) Antenatal antecedents of moderate and severe cerebral palsy. Paediatr Perinat Epidemiol 9:171–184

    Article  CAS  PubMed  Google Scholar 

  16. Hagan R, Benninger H, Chiffings D, Evans S, French N (1996) Very preterm birth—a regional study: Part 1. Maternal and obstetric factors. Br J Obstet Gynaecol 103:230–238

    CAS  PubMed  Google Scholar 

  17. Obed JY, Adewole IF (1997) Antepartum haemorrhage: the influence of first trimester uterine bleeding. West Afr J Med 16:24–26

    CAS  PubMed  Google Scholar 

  18. Rose GL, Chapman MG (1986) Aetiological factors in placenta praevia—a case controlled study. Br J Obstet Gynaecol 93:586–588

    CAS  PubMed  Google Scholar 

  19. Ananth CV, Demissie K, Smulian JC, Vintzileos AM (2003) Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 188:275–281

    Article  PubMed  Google Scholar 

  20. Faiz AS, Ananth CV (2003) Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 13:175–190

    CAS  PubMed  Google Scholar 

  21. Ananth CV, Wilcox AJ, Savitz DA, Bowes WA Jr, Luther ER (1996) Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Obstet Gynecol 88:511–516

    Article  CAS  PubMed  Google Scholar 

  22. Karegard M, Gennser G (1986) Incidence and recurrence rate of abruptio placentae in Sweden. Obstet Gynecol 67:523–528

    CAS  PubMed  Google Scholar 

  23. Kramer MS, Usher RH, Pollack R, Boyd M, Usher S (1997) Etiologic determinants of abruptio placentae. Obstet Gynecol 89:221–226

    Article  CAS  PubMed  Google Scholar 

  24. Abdella TN, Sibai BM, Hays JM Jr, Anderson GD (1984) Relationship of hypertensive disease to abruptio placentae. Obstet Gynecol 63:365–370

    CAS  PubMed  Google Scholar 

  25. Purdie DW, Young JL, Guthrie KA, Picton CE (1983) Fetal growth achievement and elevated maternal serum alpha-fetoprotein. Br J Obstet Gynaecol 90:433–436

    CAS  PubMed  Google Scholar 

  26. Redman CW (1989) Hypertension in pregnancy. In: Turnbull AC, Chamberlain G (eds) Obstetrics. Churchill Livingstone, Edinburgh, pp 515–541

    Google Scholar 

  27. Handwerker SM, Selick AM (1995) Placental abruption after insertion of catheter tip intrauterine pressure transducers: a report of four cases. J Reprod Med 40:845–849

    CAS  PubMed  Google Scholar 

  28. Pearlman MD, Tintinallli JE, Lorenz RP (1990) A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol 162:1502–1507

    CAS  PubMed  Google Scholar 

  29. Miller JM Jr, Boudreaux MC, Regan FA (1995) A case-control study of cocaine use in pregnancy. Am J Obstet Gynecol 172:180–185

    Article  PubMed  Google Scholar 

  30. Hulse GK, Milne E, English DR, Holman CD (1998) Assessing the relationship between maternal opiate use and antepartum haemorrhage. Addiction 93:1553–1558

    Article  CAS  PubMed  Google Scholar 

  31. Gonen R, Hannah ME, Milligan JE (1989) Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae? Obstet Gynecol 74:347–350

    CAS  PubMed  Google Scholar 

  32. Rice JP, Kay HH, Mahony BS (1989) The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol 160:1212–1216

    CAS  PubMed  Google Scholar 

  33. Donald I, Abdulla U (1967) Ultrasonics in obstetrics and gynaecology. Br J Radiol 40:604–611

    Article  CAS  PubMed  Google Scholar 

  34. Neilson JP (2003) Interventions for suspected placenta praevia. Cochrane Database Syst Rev 2:CD001998

    PubMed  Google Scholar 

  35. Tan NH, Abu M, Woo JL, Tahir HM (1995) The role of transvaginal sonography in the diagnosis of placenta praevia. Aust NZ J Obstet Gynaecol 35:42–45

    CAS  Google Scholar 

  36. Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, Bottoms SF (1997) Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol 9:22–24

    Article  PubMed  Google Scholar 

  37. Oyelese KO, Holden D, Awadh A, Coates S, Campbell S (1999) Placenta praevia: the case for transvaginal sonography. Cont Rev Obstet Gynecol 11:257–261

    Google Scholar 

  38. Oyelese Y, Smulian JC (2006) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107:927–941

    PubMed  Google Scholar 

  39. Timor-Tritsch IE, Yunis RA (1993) Confirming the safety of transvaginal sonography in patients suspected of placenta previa. Obstet Gynecol 81:742–744

    CAS  PubMed  Google Scholar 

  40. Hertzberg BS, Bowie JD, Carroll BA, Kliewer MA, Weber TM (1992) Diagnosis of placenta previa during the third trimester: role of transperineal sonography. AJR Am J Roentgenol 159:83–87

    CAS  PubMed  Google Scholar 

  41. Taipale P, Hiilesmaa V, Ylostalo P (1998) Transvaginal ultrasonography at 18–23 weeks in predicting placenta previa at delivery. Ultrasound Obstet Gynecol 12:422–425

    Article  CAS  PubMed  Google Scholar 

  42. Lauria MR, Smith RS, Treadwell MC, Comstock CH, Kirk JS, Lee W, Bottoms SF (1996) The use of second-trimester transvaginal sonography to predict placenta previa. Ultrasound Obstet Gynecol 8:337–340

    Article  CAS  PubMed  Google Scholar 

  43. Bhide A, Thilaganathan B (2004) Recent advances in the management of placenta previa. Curr Opin Obstet Gynecol 16:447–451

    Article  PubMed  Google Scholar 

  44. Benirschke K, Kaufmann P (2000) Pathology of the human placenta, 4th edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  45. Kayem G, Grange G, Schmitz T (2006) Clinical aspects and management of morbidly adherent placenta. Eur Clin Obstet Gynaecol (in press). DOI 10.1007/s11296-006-0043-8

  46. Powell MC, Buckley J, Price H, Worthington BS, Symonds EM (1986) Magnetic resonance imaging and placenta previa. Am J Obstet Gynecol 154:565–569

    CAS  PubMed  Google Scholar 

  47. Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP (1987) Sonographic spectrum of placental abruption. AJR Am J Roentgenol 148:161–164

    CAS  PubMed  Google Scholar 

  48. Bewley S, Cooper D, Campbell S (1991) Doppler investigation of uteroplacental blood flow resistance in the second trimester: a screening study for pre-eclampsia and intrauterine growth retardation. Br J Obstet Gynaecol 98:871–879

    CAS  PubMed  Google Scholar 

  49. Oosterhof H, Aarnoudse JG (1991) Placental abruption preceded by abnormal flow velocity waveforms in the uterine arteries. Case report. Br J Obstet Gynaecol 98:225–226

    CAS  PubMed  Google Scholar 

  50. Lam CM, Wong SF, Chow KM, Ho LC (2000) Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery. J Obstet Gynaecol 20:27–31

    Article  CAS  PubMed  Google Scholar 

  51. Lam CM, Wong SF (2002) Risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage: retrospective study. Hong Kong Med J 8:163–166

    CAS  PubMed  Google Scholar 

  52. Love CD, Fernando KJ, Sargent L, Hughes RG (2004) Major placenta praevia should not preclude out-patient management. Eur J Obstet Gynecol Reprod Biol 117:24–29

    Article  PubMed  Google Scholar 

  53. Corr P (2001) Arterial embolization for haemorrhage in the obstetric patient. Best Pract Res Clin Obstet Gynaecol 15:557–561

    Article  CAS  PubMed  Google Scholar 

  54. Mitty HA, Sterling KM, Alvarez M, Gendler R (1993) Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy. Radiology 188:183–187

    CAS  PubMed  Google Scholar 

  55. Portal P (1685) The compleat practice of men and women midwives: or the true manner of assisting a woman in child-bearing. (English translation). J Johnson, London

    Google Scholar 

  56. Baskett TF (2002) Edward Rigby (1747–1821) of Norwich and his essay on the uterine haemorrhage. J R Soc Med 95:618–622

    Article  PubMed  Google Scholar 

  57. Baskett TF (2001) Of violent floodings in pregnancy: evolution of the management of placenta praevia. In: Sturdee D, Olah K, Keene D (eds) Yearbook of obstetrics & gynaecology. RCOG, London, pp 1–14

    Google Scholar 

  58. Amy JJ (2006) Management of severe postpartum haemorrhage: an updated protocol. Eur Clin Obstet Gynaecol 2 (in press). DOI 10.1007/s11296-006-0047-4

  59. Hong JY, Jee YS, Yoon HJ, Kim SM (2003) Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth 12:12–16

    Article  PubMed  Google Scholar 

  60. Frederiksen MC, Glassenberg R, Stika CS (1999) Placenta previa: a 22-year analysis. Am J Obstet Gynecol 180:1432–1437

    Article  CAS  PubMed  Google Scholar 

  61. Dinsmoor MJ, Hogg BB (1995) Autologous blood donation with placenta previa: is it feasible? Am J Perinatol 12:382–384

    Article  CAS  PubMed  Google Scholar 

  62. Rasmussen S, Irgens LM, Bergsjo P, Dalaker K (1996) Perinatal mortality and case fatality after placental abruption in Norway 1967–1991. Acta Obstet Gynecol Scand 75:229–234

    CAS  PubMed  Google Scholar 

  63. Basu HK (1969) Fibrinolysis and abruptio placentae. J Obstet Gynaecol Br Commonw 76:481–496

    CAS  PubMed  Google Scholar 

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Correspondence to Jean Calleja-Agius.

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Calleja-Agius, J., Custo, R., Brincat, M.P. et al. Placental abruption and placenta praevia. Eur Clinics Obstet Gynaecol 2, 121–127 (2006). https://doi.org/10.1007/s11296-006-0046-5

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