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:

  1. Decidual hemorrhage.
    • Blood in the decidua.
  2. 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

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.

See also

References

  1. Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O (2006). "Clinical presentation and risk factors of placental abruption". Acta Obstet Gynecol Scand 85 (6): 700–5. doi:10.1080/00016340500449915. PMID 16752262.
  2. CS. 7 February 2011.