Placental abruption (mechanism of disease)

This is a flowchart on placental abruption, covering the etiology, pathophysiology, and manifestations.
ADDITIONAL TAGS:
Multiple gestation (e.g., twins)
Risk factors / SDOH
Cell / tissue damage
Structural factors
Placental abruption
Medicine / iatrogenic
Infectious / microbial
Biochem / metabolic
Immunology / inflammation
Signs / symptoms
Tests / imaging / labs
Environmental / drugs
Reproductive pathology
Flow physiology
Pathophysiology
Etiology
Manifestations
Placental abruption:
partial or complete sep- aration of placenta from uterus prior to delivery
→ hemorrhage from fetal and maternal vessels
+/- disruption of oxygen and nutrients to the fetus
Hypertension
Prior placental abruption
Smoking, alcohol
General patient risk factors:
Cocaine use
Preeclampsia
Sudden uterine decompression
Specific to individual pregnancy:
Polyhydramnios
Short umbilical cord
Car accident
Fall
Violence
Abdominal trauma
Vascular changes
Vascular networks connecting the uterine lining and the maternal side of the placenta are torn
Stretching of the uterus
The uterus, a muscle, is elastic and can stretch suddenly, whereas the placenta remains stable
Blood clot on the maternal side of a delivered placenta
Class 0: Asymptomatic
Diagnosis is made retrospectively
small amount of bleeding
Class 1: Mild
Slight uterine tenderness
Normal maternal vitals
No fetal distress
moderate amount bleeding
Class 2: Moderate
Significant uterine tenderness with tetanic contractions
Maternal tachycardia and/or orthostatic changes in BP
Diminished or absent fetal movement; decelerations
Hypofibrinogenemia
heavy amount bleeding
Class 3: Severe
Tetanic uterus; board-like consistency on palpation
Maternal shock
Fetal death
Hypofibrinogenemia and coagulopathy; +/- DIC
Results of blood loss and massive coagulation; the placenta is rich in tissue thromboplastin, which is released
Blood dissects through myometrial wall → causes characteristic woody/rigid uterus
Recurrence in 4 to 12% of cases
Mothers can present w signs of hypovolemic shock without evident vaginal bleeding
Trauma

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