Abruptio Placentae and its Relations to Maternal and Neonatal Outcomes: A Narrative Review of Recent Literature
Main Article Content
Placental abruption (PA) is the premature separation of the placenta from the uterine wall, typically occurring after 20 weeks of gestation. Affecting approximately 1.4% of pregnancies, PA poses significant risks to both maternal and fetal health, including life-threatening complications and increased mortality. The etiology of PA involves chronic and acute pathways such as vasculopathy, inflammation, and oxidative stress, often exacerbated by risk factors like maternal hypertension, advanced age, smoking, and a history of prior abruption. This review aims to explore the multifactorial nature of placental abruption, improving understanding of its diagnosis, management, and prevention strategies. A comprehensive review of the literature was conducted, focusing on the clinical presentation, diagnostic methods, management approaches, and preventive strategies related to placental abruption. Results show diagnosis of PA is primarily clinical, with symptoms including vaginal bleeding, abdominal pain, and uterine contractions, confirmed post-delivery. While ultrasonography is used in diagnosis, its limitations have prompted the use of advanced imaging techniques. Management ranges from expectant monitoring to emergency cesarean delivery, depending on severity. PA is associated with increased risks of postpartum hemorrhage, infection, maternal death, preterm birth, low fetal birth weight, and neonatal respiratory distress. Preventive strategies targeting hypercoagulability with anticoagulants remain inconclusive and are generally not recommended. Lifestyle interventions show potential but require further investigation. The review underscores the importance of understanding PA's multifactorial nature to improve current diagnostic, management, and preventive approaches. Further research into novel interventions is essential for better outcomes.
Keywords:
Placental abruption, maternal, fetal, outcome, prevention
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Amikam, U., Botkovsky, Y., Hochberg, A., Cohen, A., Levin, I., Yogev, Y., Hiersch, L., & Lavie, A. (2024). Risk factors for relaparotomy after a cesarean delivery: A case-control study. BMC Pregnancy and Childbirth, 24(1), 284. https://doi.org/10.1186/s12884-024-06455-6
B?czkowska, M., Kosi?ska-Kaczy?ska, K., Zgliczy?ska, M., Brawura-Biskupski-Samaha, R., Rebizant, B., & Ciebiera, M. (2022). Epidemiology, risk factors, and perinatal outcomes of placental abruption—Detailed annual data and clinical perspectives from Polish tertiary center. International Journal of Environmental Research and Public Health, 19(9), 5148. https://doi.org/10.3390/ijerph19095148
Baumfeld, Y., Herskovitz, R., Bar Niv, Z., Mastrolia, S. A., & Weintraub, A. Y. (2017). Placenta associated pregnancy complications in pregnancies complicated with placenta previa. Taiwanese Journal of Obstetrics and Gynecology, 56(3), 331–335. https://doi.org/10.1016/j.tjog.2017.04.012
Brandt, J. S., & Ananth, C. V. (2023). Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management. American Journal of Obstetrics and Gynecology, 228(5), S1313–S1329. https://doi.org/10.1016/j.ajog.2022.06.059
Bruinsma, M. A. W., De Boer, M. A., Prins, S., & Abheiden, C. N. H. (2022). Does placental abruption cause neonatal anemia? Acta Obstetricia et Gynecologica Scandinavica, 101(8), 917–922. https://doi.org/10.1111/aogs.14376
Downes, K. L., Grantz, K. L., & Shenassa, E. D. (2017). Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: A systematic review. American Journal of Perinatology, 34(10), 935–957. https://doi.org/10.1055/s-0037-1599149
Downes, K. L., Shenassa, E. D., & Grantz, K. L. (2017). Neonatal outcomes associated with placental abruption. American Journal of Epidemiology, 186(12), 1319–1328. https://doi.org/10.1093/aje/kwx202
Heerboth, S., Allshouse, A. A., Maves, K., & Campbell, H. (2023). Expectant management of placental abruption: Risk factors for progression and morbidity. American Journal of Obstetrics and Gynecology, 228(1), S225. https://doi.org/10.1016/j.ajog.2022.11.414
Hiersch, L., Shinar, S., Melamed, N., Aviram, A., Hadar, E., Yogev, Y., & Ashwal, E. (2017). Recurrent placenta-mediated complications in women with three consecutive deliveries. Obstetrics & Gynecology, 129(3), 416–421. https://doi.org/10.1097/AOG.0000000000001890
Jyotsna, G., Tayade, S., Sharma, S., Patel, D., & Singh, S. (2023). Placental abruption complicated by the Couvelaire uterus: A high-risk obstetric case at 30 weeks gestation. Cureus. https://doi.org/10.7759/cureus.46832
Khazaei, S., & Jenabi, E. (2020). The association between polyhydramnios and the risk of placenta abruption: A meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 33(17), 3035–3040. https://doi.org/10.1080/14767058.2019.1566898
Kinoshita, T., Takeshita, N., Takashima, A., Yasuda, Y., Ishida, H., & Manrai, M. (2014). A case of life-threatening obstetrical hemorrhage secondary to placental abruption at 17 weeks of gestation. Clinics and Practice, 4(1), 605. https://doi.org/10.4081/cp.2014.605
Kovo, M., & Schreiber, L. (2021). Placental histopathology and pregnancy outcome in placental abruption. Thrombosis Update, 5, 100087. https://doi.org/10.1016/j.tru.2021.100087
Li, Y., Tian, Y., Liu, N., Chen, Y., & Wu, F. (2019). Analysis of 62 placental abruption cases: Risk factors and clinical outcomes. Taiwanese Journal of Obstetrics and Gynecology, 58(2), 223–226. https://doi.org/10.1016/j.tjog.2019.01.010
Maraka, S., Singh Ospina, N. M., O’Keeffe, D. T., Espinosa De Ycaza, A. E., Gionfriddo, M. R., Erwin, P. J., Coddington, C. C., Stan, M. N., Murad, M. H., & Montori, V. M. (2016). Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid, 26(4), 580–590. https://doi.org/10.1089/thy.2015.0418
Mills, G., Badeghiesh, A., Suarthana, E., Baghlaf, H., & Dahan, M. H. (2020). Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: A population study of 9.1 million births. Human Reproduction, 35(8), 1914–1921. https://doi.org/10.1093/humrep/deaa144
Mishra, R., & Misra, A. P. (2019). Abruptio placenta and its maternal and fetal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(8), 3323. https://doi.org/10.18203/2320-1770.ijrcog20193559
Ni, S., Wang, X., & Cheng, X. (2021). The comparison of placental abruption coupled with and without preeclampsia and/or intrauterine growth restriction in singleton pregnancies. The Journal of Maternal-Fetal & Neonatal Medicine, 34(9), 1395–1400. https://doi.org/10.1080/14767058.2019.1637850
Nkwabong, E., Moussi, O. S. T., & Fouedjio, J. (2023). Risk factors for placental abruption. Tropical Doctor, 53(1), 37–40. https://doi.org/10.1177/00494755221116716
Odendaal, H., Wright, C., Schubert, P., Boyd, T. K., Roberts, D. J., Brink, L., Nel, D., & Groenewald, C. (2020). Associations of maternal smoking and drinking with fetal growth and placental abruption. European Journal of Obstetrics & Gynecology and Reproductive Biology, 253, 95–102. https://doi.org/10.1016/j.ejogrb.2020.07.018
Page, N., Roloff, K., Modi, A. P., Dong, F., & Neeki, M. M. (2020). Management of placental abruption following blunt abdominal trauma. Cureus. https://doi.org/10.7759/cureus.10337
Parker, J., Hofstee, P., & Brennecke, S. (2024). Prevention of pregnancy complications using a multimodal lifestyle, screening, and medical model. Journal of Clinical Medicine, 13(15), 4344. https://doi.org/10.3390/jcm13154344
Qiu, Y., Wu, L., Xiao, Y., & Zhang, X. (2021). Clinical analysis and classification of placental abruption. The Journal of Maternal-Fetal & Neonatal Medicine, 34(18), 2952–2956. https://doi.org/10.1080/14767058.2019.1675625
Roberge, S., Bujold, E., & Nicolaides, K. H. (2018). Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage. American Journal of Obstetrics and Gynecology, 218(5), 483–489. https://doi.org/10.1016/j.ajog.2017.12.238
Shinde, G. R., Vaswani, B. P., Patange, R. P., Laddad, M. M., & Bhosale, R. B. (2016). Diagnostic performance of ultrasonography for detection of abruption and its clinical correlation and maternal and foetal outcome. Journal of Clinical and Diagnostic Research, 10(8), QC04–QC07. https://doi.org/10.7860/JCDR/2016/19247.8288
Skeith, L., Blondon, M., & Ní Áinle, F. (2020). Understanding and preventing placenta-mediated pregnancy complications. Hämostaseologie, 40(03), 356–363. https://doi.org/10.1055/a-1184-8388
Skeith, L., & Rodger, M. (2017). Anticoagulants to prevent recurrent placenta-mediated pregnancy complications: Is it time to put the needles away? Thrombosis Research, 151, S38–S42. https://doi.org/10.1016/S0049-3848(17)30065-8
Suzuki, R., Furuya, N., Hasegawa, J., Homma, C., Iwahata, Y., & Suzuki, N. (2022). Ultrasonographic findings of placental abruption observed on superb microvascular imaging. Taiwanese Journal of Obstetrics and Gynecology, 61(4), 713–716. https://doi.org/10.1016/j.tjog.2021.08.007
Zhang, J. T., Lee, R., Sauer, M. V., & Ananth, C. V. (2024). Risks of placental abruption and preterm delivery in patients undergoing assisted reproduction. JAMA Network Open, 7(7), e2420970. https://doi.org/10.1001/jamanetworkopen.2024.20970
Amikam, U., Botkovsky, Y., Hochberg, A., Cohen, A., Levin, I., Yogev, Y., Hiersch, L., & Lavie, A. (2024). Risk factors for relaparotomy after a cesarean delivery: A case-control study. BMC Pregnancy and Childbirth, 24(1), 284. https://doi.org/10.1186/s12884-024-06455-6
B?czkowska, M., Kosi?ska-Kaczy?ska, K., Zgliczy?ska, M., Brawura-Biskupski-Samaha, R., Rebizant, B., & Ciebiera, M. (2022). Epidemiology, risk factors, and perinatal outcomes of placental abruption—Detailed annual data and clinical perspectives from Polish tertiary center. International Journal of Environmental Research and Public Health, 19(9), 5148. https://doi.org/10.3390/ijerph19095148
Baumfeld, Y., Herskovitz, R., Bar Niv, Z., Mastrolia, S. A., & Weintraub, A. Y. (2017). Placenta associated pregnancy complications in pregnancies complicated with placenta previa. Taiwanese Journal of Obstetrics and Gynecology, 56(3), 331–335. https://doi.org/10.1016/j.tjog.2017.04.012
Brandt, J. S., & Ananth, C. V. (2023). Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management. American Journal of Obstetrics and Gynecology, 228(5), S1313–S1329. https://doi.org/10.1016/j.ajog.2022.06.059
Bruinsma, M. A. W., De Boer, M. A., Prins, S., & Abheiden, C. N. H. (2022). Does placental abruption cause neonatal anemia? Acta Obstetricia et Gynecologica Scandinavica, 101(8), 917–922. https://doi.org/10.1111/aogs.14376
Downes, K. L., Grantz, K. L., & Shenassa, E. D. (2017). Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: A systematic review. American Journal of Perinatology, 34(10), 935–957. https://doi.org/10.1055/s-0037-1599149
Downes, K. L., Shenassa, E. D., & Grantz, K. L. (2017). Neonatal outcomes associated with placental abruption. American Journal of Epidemiology, 186(12), 1319–1328. https://doi.org/10.1093/aje/kwx202
Heerboth, S., Allshouse, A. A., Maves, K., & Campbell, H. (2023). Expectant management of placental abruption: Risk factors for progression and morbidity. American Journal of Obstetrics and Gynecology, 228(1), S225. https://doi.org/10.1016/j.ajog.2022.11.414
Hiersch, L., Shinar, S., Melamed, N., Aviram, A., Hadar, E., Yogev, Y., & Ashwal, E. (2017). Recurrent placenta-mediated complications in women with three consecutive deliveries. Obstetrics & Gynecology, 129(3), 416–421. https://doi.org/10.1097/AOG.0000000000001890
Jyotsna, G., Tayade, S., Sharma, S., Patel, D., & Singh, S. (2023). Placental abruption complicated by the Couvelaire uterus: A high-risk obstetric case at 30 weeks gestation. Cureus. https://doi.org/10.7759/cureus.46832
Khazaei, S., & Jenabi, E. (2020). The association between polyhydramnios and the risk of placenta abruption: A meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 33(17), 3035–3040. https://doi.org/10.1080/14767058.2019.1566898
Kinoshita, T., Takeshita, N., Takashima, A., Yasuda, Y., Ishida, H., & Manrai, M. (2014). A case of life-threatening obstetrical hemorrhage secondary to placental abruption at 17 weeks of gestation. Clinics and Practice, 4(1), 605. https://doi.org/10.4081/cp.2014.605
Kovo, M., & Schreiber, L. (2021). Placental histopathology and pregnancy outcome in placental abruption. Thrombosis Update, 5, 100087. https://doi.org/10.1016/j.tru.2021.100087
Li, Y., Tian, Y., Liu, N., Chen, Y., & Wu, F. (2019). Analysis of 62 placental abruption cases: Risk factors and clinical outcomes. Taiwanese Journal of Obstetrics and Gynecology, 58(2), 223–226. https://doi.org/10.1016/j.tjog.2019.01.010
Maraka, S., Singh Ospina, N. M., O’Keeffe, D. T., Espinosa De Ycaza, A. E., Gionfriddo, M. R., Erwin, P. J., Coddington, C. C., Stan, M. N., Murad, M. H., & Montori, V. M. (2016). Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid, 26(4), 580–590. https://doi.org/10.1089/thy.2015.0418
Mills, G., Badeghiesh, A., Suarthana, E., Baghlaf, H., & Dahan, M. H. (2020). Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: A population study of 9.1 million births. Human Reproduction, 35(8), 1914–1921. https://doi.org/10.1093/humrep/deaa144
Mishra, R., & Misra, A. P. (2019). Abruptio placenta and its maternal and fetal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 8(8), 3323. https://doi.org/10.18203/2320-1770.ijrcog20193559
Ni, S., Wang, X., & Cheng, X. (2021). The comparison of placental abruption coupled with and without preeclampsia and/or intrauterine growth restriction in singleton pregnancies. The Journal of Maternal-Fetal & Neonatal Medicine, 34(9), 1395–1400. https://doi.org/10.1080/14767058.2019.1637850
Nkwabong, E., Moussi, O. S. T., & Fouedjio, J. (2023). Risk factors for placental abruption. Tropical Doctor, 53(1), 37–40. https://doi.org/10.1177/00494755221116716
Odendaal, H., Wright, C., Schubert, P., Boyd, T. K., Roberts, D. J., Brink, L., Nel, D., & Groenewald, C. (2020). Associations of maternal smoking and drinking with fetal growth and placental abruption. European Journal of Obstetrics & Gynecology and Reproductive Biology, 253, 95–102. https://doi.org/10.1016/j.ejogrb.2020.07.018
Page, N., Roloff, K., Modi, A. P., Dong, F., & Neeki, M. M. (2020). Management of placental abruption following blunt abdominal trauma. Cureus. https://doi.org/10.7759/cureus.10337
Parker, J., Hofstee, P., & Brennecke, S. (2024). Prevention of pregnancy complications using a multimodal lifestyle, screening, and medical model. Journal of Clinical Medicine, 13(15), 4344. https://doi.org/10.3390/jcm13154344
Qiu, Y., Wu, L., Xiao, Y., & Zhang, X. (2021). Clinical analysis and classification of placental abruption. The Journal of Maternal-Fetal & Neonatal Medicine, 34(18), 2952–2956. https://doi.org/10.1080/14767058.2019.1675625
Roberge, S., Bujold, E., & Nicolaides, K. H. (2018). Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage. American Journal of Obstetrics and Gynecology, 218(5), 483–489. https://doi.org/10.1016/j.ajog.2017.12.238
Shinde, G. R., Vaswani, B. P., Patange, R. P., Laddad, M. M., & Bhosale, R. B. (2016). Diagnostic performance of ultrasonography for detection of abruption and its clinical correlation and maternal and foetal outcome. Journal of Clinical and Diagnostic Research, 10(8), QC04–QC07. https://doi.org/10.7860/JCDR/2016/19247.8288
Skeith, L., Blondon, M., & Ní Áinle, F. (2020). Understanding and preventing placenta-mediated pregnancy complications. Hämostaseologie, 40(03), 356–363. https://doi.org/10.1055/a-1184-8388
Skeith, L., & Rodger, M. (2017). Anticoagulants to prevent recurrent placenta-mediated pregnancy complications: Is it time to put the needles away? Thrombosis Research, 151, S38–S42. https://doi.org/10.1016/S0049-3848(17)30065-8
Suzuki, R., Furuya, N., Hasegawa, J., Homma, C., Iwahata, Y., & Suzuki, N. (2022). Ultrasonographic findings of placental abruption observed on superb microvascular imaging. Taiwanese Journal of Obstetrics and Gynecology, 61(4), 713–716. https://doi.org/10.1016/j.tjog.2021.08.007
Zhang, J. T., Lee, R., Sauer, M. V., & Ananth, C. V. (2024). Risks of placental abruption and preterm delivery in patients undergoing assisted reproduction. JAMA Network Open, 7(7), e2420970. https://doi.org/10.1001/jamanetworkopen.2024.20970
