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Clinical Images  |   June 2017
Abruptio Placentae
Author Notes
  • From the Department of Obstetrics and Gynecology at the NYU Lutheran Medical Center in Brooklyn. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Daniel Martingano, DO, NYU Lutheran Medical Center, 150 55th St, Brooklyn, NY 11220-2508. E-mail: daniel.martingano@nyumc.org
     
Article Information
Imaging / Obstetrics and Gynecology / Clinical Images
Clinical Images   |   June 2017
Abruptio Placentae
The Journal of the American Osteopathic Association, June 2017, Vol. 117, 404. doi:10.7556/jaoa.2017.081
The Journal of the American Osteopathic Association, June 2017, Vol. 117, 404. doi:10.7556/jaoa.2017.081
A17-year-old woman, gravida 1, para 0, at 39 weeks gestational age with an uncomplicated prenatal course presented to the labor and delivery department in active labor. Cervical examination revealed dilation of 6 cm, 80% effacement, and −2 station. The patient was admitted and given epidural anesthesia. Six hours later, cervical examination revealed full-dilation uterine contractions at least 5 minutes apart, adequate to facilitate labor progress. Profuse vaginal bleeding, hypertonic uterine contractions, and variable decelerations on fetal heart tracing were noted. Soon after, the fetus was successfully delivered. The newborn had APGAR scores of 7 and 8 at 1 and 5 minutes, respectively. Maternal fibrinogen was 215 mg/dL after delivery. Examination of the placenta showed that hemorrhage into the decidua basalis caused partial separation of the placenta from the uterus (image, arrow) during the active phase of labor, which, along with clinical findings, demonstrated a class 2 abruptio placentae. 
Abruptio placentae refers to placental detachment before delivery of the fetus caused by bleeding at the decidual placental interface.1 The primary clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions and a nonreassuring fetal heart tracing.2 Placental abruption can involve complete separation of the placenta from the uterine wall, which commonly leads to fetal death, or partial separation, which confers a more benign prognosis.2,3 
References
Atkinson AL, Santolaya-Forgas J, Blitzer DN, et al Risk factors for perinatal mortality in patients admitted to the hospital with the diagnosis of placental abruption. J Matern Fetal Neonatal Med. 2015;28(5):594-597. doi: 10.3109/14767058.2014.927427 [CrossRef] [PubMed]
Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140-149. doi: 10.1111/j.1600-0412.2010.01030.x [CrossRef] [PubMed]
Gelaye B, Sumner SJ, McRitchie S, et al. Maternal early pregnancy serum metabolomics profile and abnormal vaginal bleeding as predictors of placental abruption: a prospective study. PLoS One. 2016;11(6):e0156755. doi: 10.1371/journal.pone.0156755 [CrossRef] [PubMed]