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