Placental abruption
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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.