Review Question - QID 107221

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Abruptio Placentae Epidemiology Risk factors QID: 107221 (M2.OB.15.4675)

QID 107221 (Type "107221" in App Search)

A 32-year-old G2P1 female at 30 weeks gestation presents to the emergency department with complaints of vaginal bleeding and severe abdominal pain. She states that she began feeling poorly yesterday with a stomach-ache, nausea, and vomiting. She first noted a small amount of spotting this morning that progressed to much larger amounts of vaginal bleeding with worsened abdominal pain a few hours later, prompting her to come to the emergency department. Her previous pregnancy was without complications, and the fetus was delivered at 40 weeks by Cesarean section. Fetal heart monitoring shows fetal distress with late decelerations. Which of the following is a risk factor for this patient's presenting condition?

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Hyperlipidemia

1/37

Hypertension

73%

27/37

Patient age

0/37

Prior Cesarean section

22%

8/37

Singleton pregnancy

0/37

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This patient's presentation is most suggestive of placental abruption. Hypertension (either chronic or pregnancy-induced) increases the risk of placental abruption.

Additional risk factors for placental abruption include previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40. Placental abruption, the premature separation of a normally implanted placenta, and placenta previa are the two most common causes of third trimester bleeding. Placenta previa presents with painless bleeding, while abruption typically manifests with abdominal pain.

Sakornbut et al. review late pregnancy bleeding. Besides abruption, other causes include placenta previa (implantation of the placenta over the cervical os) and vasa previa (fetal vessels traverse the cervical os). Abruption may necessitate rapid operative delivery to prevent neonatal morbidity or demise. Management of vaginal bleeding of any cause should include assessment of fetal and maternal status, fluid resuscitation, blood products as needed, and an appropriately timed delivery.

Tikkanen discusses the epidemiology and outcomes of placental abruption. 0.6-1.0% of pregnancies are complicated by placental abruption. Maternal complications include obstetric hemorrhage, need for blood transfusion, disseminated intravascular coagulation, renal failure, or emergency hysterectomy. Fetal consequences include low birthweight, preterm delivery, hypoxia/asphyxia, stillbirth, or perinatal death.

Illustration A shows how a placental abruption may present with either visible or concealed bleeding with a retroplacental clot. Illustration B shows the different types of placenta previa. Illustration C depicts vasa previa, which is a less common cause of third trimester bleeding compared to placenta previa and abruption.

Incorrect Answers:
Answer 1: Hyperlipidemia does not have a known association with placental abruption.
Answer 3: Although the risk of placental abruption increases with age, a patient's risk is not significantly elevated until after age 40.
Answer 4: Prior C-section is a risk factor for placenta previa.
Answer 5: A singleton pregnancy has the lowest risk for placental abruption; a multiple pregnancy increases the risk of this complication.

ILLUSTRATIONS: