Causes

The cause of abruptio placentae is unknown; however, any condition that causes vascular changes at the placental level may contribute to premature separation of the placenta. Hypertension, preterm premature rupture of membranes, smoking, and cocaine abuse are the most common associated factors. A short umbilical cord, thrombophilias, external trauma, fibroids (especially those located behind the placental implantation site), severe diabetes or renal disease, and vena caval compression are other predisposing factors.

16 Abruptio Placentae

• TABLE 3 Grading System for Abruptions

Grade 0 Less than 10% of the total placental surface has detached; the patient has no symptoms;

however, a small retroplacental clot is noted at birth. Grade I Approximately 10%-20% of the total placental surface has detached; vaginal bleeding and mild uterine tenderness are noted; however, the mother and fetus are in no distress. Grade II Approximately 20%-50% of the total placental surface has detached; the patient has uterine tenderness and tetany; bleeding can be concealed or is obvious; signs of fetal distress are noted; the mother is not in hypovolemic shock. Grade III More than 50% of the placental surface has detached; uterine tetany is severe; bleeding can be concealed or is obvious; the mother is in shock and often experiencing coagulopathy; fetal death occurs.

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