Difference between revisions of "Placental abruption"
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# | '''Placental abruption''' is premature separation of the [[placenta]] from the [[uterus]]. | ||
==General== | |||
Classic clinical manifestations:<ref name=pmid16752262>{{cite journal |author=Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O |title=Clinical presentation and risk factors of placental abruption |journal=Acta Obstet Gynecol Scand |volume=85 |issue=6 |pages=700–5 |year=2006 |pmid=16752262 |doi=10.1080/00016340500449915 |url=}}</ref> | |||
*Vaginal bleeding (~70%). | |||
*Abdominal pain (~50%). | |||
*Fetal heart rate abnormalities (~70%). | |||
Sign-out: | |||
*Pathologists should sign-out this as "focal adherent retroplacental hematoma". | |||
**The pathologic findings may be due to abruption or manual removal of the placenta. | |||
==Gross== | |||
Features:<ref>CS. 7 February 2011.</ref> | |||
*Large adherent blood clot. | |||
*Disc depression on maternal side. | |||
Notes: | |||
*Loosely attached clot less convincing. | |||
*Central haemorrhage is the most worrisome. | |||
==Microscopic== | |||
Features: | |||
#Decidual hemorrhage. | |||
#*Blood in the decidua. | |||
#Intravillous hemorrhage, [[AKA]] villous stromal hemorrhage. | |||
#*"Bags of blood" - blood outside of vessels in the villi. | |||
#**Should not be confused with congested villi. | |||
Notes: | |||
*There are '''no''' definitive microscopic findings for placental abruption. | |||
*Intravillous hemorrhage is non-specific - may arise in the following: early placental infarct, cord compression, abdominal trauma. | |||
==Sign out== | |||
===Compatible=== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- PLACENTAL DISC WITH A CENTRAL THROMBUS (1.9 CM MAXIMAL DIMENSION). | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
</pre> | |||
===Usual nonspecific findings=== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI, TWO SMALL PLACENTAL INFARCTS | |||
(0.8 CM AND 0.5 CM IN MAXIMAL DIMENSION) AND FOCAL PROMINENCE OF SYNCYTIAL KNOTS. | |||
COMMENT: | |||
There is no decidual hemorrhage or intravillous hemorrhage. The prominent syncytial knots | |||
are a nonspecific finding suggestive of (focal) ischemia. | |||
</pre> | |||
Note: | |||
*The above is not diagnostic nor does it exclude the diagnosis of abruption. | |||
==See also== | |||
*[[Placenta]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Placenta]] | |||
Latest revision as of 17:29, 25 June 2014
Placental abruption is premature separation of the placenta from the uterus.
General
Classic clinical manifestations:[1]
- Vaginal bleeding (~70%).
- Abdominal pain (~50%).
- Fetal heart rate abnormalities (~70%).
Sign-out:
- Pathologists should sign-out this as "focal adherent retroplacental hematoma".
- The pathologic findings may be due to abruption or manual removal of the placenta.
Gross
Features:[2]
- Large adherent blood clot.
- Disc depression on maternal side.
Notes:
- Loosely attached clot less convincing.
- Central haemorrhage is the most worrisome.
Microscopic
Features:
- Decidual hemorrhage.
- Blood in the decidua.
- Intravillous hemorrhage, AKA villous stromal hemorrhage.
- "Bags of blood" - blood outside of vessels in the villi.
- Should not be confused with congested villi.
- "Bags of blood" - blood outside of vessels in the villi.
Notes:
- There are no definitive microscopic findings for placental abruption.
- Intravillous hemorrhage is non-specific - may arise in the following: early placental infarct, cord compression, abdominal trauma.
Sign out
Compatible
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: - PLACENTAL DISC WITH A CENTRAL THROMBUS (1.9 CM MAXIMAL DIMENSION). - THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. - FETAL MEMBRANES WITHIN NORMAL LIMITS.
Usual nonspecific findings
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: - THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. - FETAL MEMBRANES WITHIN NORMAL LIMITS. - PLACENTAL DISC WITH THIRD TRIMESTER VILLI, TWO SMALL PLACENTAL INFARCTS (0.8 CM AND 0.5 CM IN MAXIMAL DIMENSION) AND FOCAL PROMINENCE OF SYNCYTIAL KNOTS. COMMENT: There is no decidual hemorrhage or intravillous hemorrhage. The prominent syncytial knots are a nonspecific finding suggestive of (focal) ischemia.
Note:
- The above is not diagnostic nor does it exclude the diagnosis of abruption.