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Review article

The main features of placental abruption - clinical presentation and treatment

Sandra Babić1, Miljana Z. Jovandarić2
  • University Clinical Center of Serbia, Clinic for Gynecology and Obstetrics, Department of Fertility Control, Belgrade, Serbia
  • University Clinical Center of Serbia, Clinic for Gynecology and Obstetrics, Department of Neonatology, Belgrade, Serbia

ABSTRACT

Placental abruption is defined as the premature separation of the placenta from the uterus. Rapid diagnosis and adequate medical intervention provide a good outcome, which is not possible in all countries. Any bleeding that occurs in the second half of pregnancy raises the suspicion of placental abruption, which is associated with fetal and maternal morbidity and mortality. The clinical picture and consequences for the fetus depend on the degree of bleeding and the amount of blood. Complete abruption leads to the disruption of fetal circulation and oxygenation, asphyxia, and stillbirth. In case of partial abruption, the consequences for the fetus depend on the degree of bleeding. In complete abruption, fetal death is inevitable unless an emergency cesarean delivery is undertaken.


INTRODUCTION

Placental abruption is one of the most common causes of maternal morbidity and perinatal mortality. It is one of the leading causes of vaginal bleeding in the second half of pregnacy (usually after the twentieth week of gestation) or just before the birth. The prevalence of pregnancies complicated by placental abruption is around 0.4-1% [1],[2]. The incidence of placental abruption in preterm births varies significantly in various parts of the world. In developed countries, around 10% of all preterm births are caused by placental abruption [3],[4].

Placental abruption is defined as the premature (before delivery) separation of the normally implanted placenta from the uterus [5],[6].

The etiology of placental abruption is multifactorial (e.g. hypertension in pregnancy, sudden uterine decompression, supine hypotensive syndrome, trauma, anomalies), although it is usually unknown why the premature separation of the normally implanted placenta occurs. Risk factors for placental abruption include maternal age (below 20 years or over 35 years), a multiple gestation pregnancy, previous placental abruption, in vitro fertilization, thrombophilia, short umbilical cord, chorioamnionitis, as well as hypertension, trauma (traffic accidents, falls) and consumption of tobacco, alcohol, and cocaine during pregnancy [7],[8].

When it comes to the pathophysiology of placental abruption, due to the pressure of a hematoma in the area where the placenta is formed (decidua basalis), the circulation between the mother and the fetus is interrupted causing hemodynamic disturbances, coagulation disorders and acute fetal distress. When the bleeding originates from the placental blood vessels, central or peripheral accumulation of blood between the placenta and the uterine wall may occur forming a retroplacental hematoma which can present as external bleeding. In the case of a central retroplacental hematoma, it is possible that large amounts of blood remain behind the placenta with no visible external bleeding [9].

Histopathological examination of the placenta may retrospectively confirm the diagnosis of placental infarction and decidual vasculopathy, but histopathological analysis is confirmative only in one-third of all cases as specific lesions are not always present [10].

In pregnant women, placental abruption is associated with the following risks: an obstetric hemorrhage, the need of blood transfusion, emergency hysterectomy, disseminated intravascular coagulation and renal failure and very often even maternal death. Due to preterm birth, there may be perinatal complications for the fetus such as low birth weight, asphyxia, and stillbirth [4],[11]. Complete abruption leads to the disruption of fetal circulation and oxygenation, asphyxia, and stillbirth. In partial abruption, the consequences for the fetus depend on the amount of blood lost, i.e. the presence of bleeding [12].

Since it can be life-threatening, it is important that placental abruption is recognized in a timely manner. The aim of this paper is to describe the clinical picture of placental abruption relying on the existing knowledge.

PLACENTAL ABRUPTION – THE CLINICAL PICTURE

The clinical picture of the mother and the fetus depends on the degree of separation (Table 1), the presence of a hematoma and its volume, the presence of bleeding and the amount of blood lost. Placental abruption is diagnosed according to the medical history and the clinical picture of the patient and only postpartum can macroscopic and histopathological examination be taken into consideration.

Table 1. The classification of placental abruption according to the extent of the separation (complete or partial) and the location of the separation (marginal or central) [13].

Table 1. The classification of placental abruption according to the extent of the separation (complete or partial) and the location of the separation (marginal or central) [<a href=13]." width="1890" height="244">

Class 1 abruption is the mildest degree of abruption which can present with a slight trickle of blood or the absence of visible external bleeding. There is tenderness or discomfort in the abdomen, a sudden pain in the abdomen or in the back and slight uterine tenderness with no contractions. Blood pressure is normal (120/80 mmHg), as well as fibrinogen value (200-400 mg/l). The fetal heart rate is normal, and it ranges from 120 to 160 beats per minute. Postpartum, the mother and newborn’s general condition is good [6].

Class 2 abruption is followed by moderate bleeding which usually means losing about 100 ml of blood and sometimes up to 500 ml like in heavy menstrual bleeding; there are uterine contractions with occasional tetanic contractions [14]. Blood pressure in the supine position is normal, but orthostatic hypotension is possible. Maternal tachycardia occurs, with over 100 beats per minute. A drop in fibrinogen value is observed (below 200 mg/dl). Cardiotocography reveals fetal distress which mainly manifests itself in reduced oscillatory amplitude. The pregnancy ends with an emergency Cesarean section. The mother’s condition is good. The newborn suffers from moderate respiratory distress due to mild intrauterine asphyxia [15]. Macroscopic examination of moderate abruption shows a formed retroplacental hematoma with thrombosis of the uterine blood vessels, compressed villi and placental infarction (Figure 1).

Figure 1. Macroscopic appearance of Class 2 placental abruption – moderate placental abruption. Retroplacental hematoma formed due to thrombosis of the uterine blood vessels on the background of compressed villi Source: Author’s documentation

Figure 1. Macroscopic appearance of Class 2 placental abruption – moderate placental abruption. Retroplacental hematoma formed due to thrombosis of the uterine blood vessels on the background of compressed villi
Source: Author’s documentation

Class 3 abruption is characterized by heavy vaginal bleeding, the painful and contracted uterus. Severe abruption is followed by the development of disseminated intravascular coagulation (DIC). Maternal laboratory analyzes show severe anemia, hemoglobin value below 70 g/L and hematocrit value below 0.30, coagulopathy characterized by elevated thrombin values, decreased fibrinogen value (below 150 mg/dl), decreased platelet count (below 140 x 109 /l) and elevated D-dimer and fibrin degradation products, as well as hemorrhagic shock. The following parameters indicate shock in the initial reversible stage: tachychardia (a rapid heart rate, over 100 beats a minute), tachypnea (more than 20 breaths per minute), hypotension (blood pressure below 100/60 mmHg), tissue acidosis, blood pH below 7.35, bicarbonate level below 12 mmol/L and oliguria (reduced urine output to < 500 ml/24 h). The therapy consists of fluid, electrolyte and plasma expander replacement, the correction of anemia through blood transfusion and very rarely inotropes as well (Dopamine, Dobutamine) [16],[17]. Surgery reveals that bleeding is present in the myometrium, in the fallopian tubes and sometimes in the peritoneal cavity as well. The uterus is enlarged, dark purple to black in color (Picture 2). The described condition is called uteroplacental apoplexy, or Couvelaire uterus, according to Dr Alexandre Couvelaire who first described it in 1911 as a rare complication of all cases of placental abruption (up to 5%) [18],[19]. In such cases, hysterectomy is often necessary due to uterine atony and resilience to standard procedures, uterine tamponade and uterine artery ligation. Due to massive hemorrhage, the loss of more than 1000 ml of blood, interruption of circulation in the umbilical vein, severe fetal asphyxia and intrauterine death may occur [20],[21],[22].

Figure 2. Macroscopic appearance of Class 3 placental abruption – severe abruption. Placenta with massive hemorrhage and an extensive retroplacental hematoma . Source: Author’s documentation

Figure 2. Macroscopic appearance of Class 3 placental abruption – severe abruption. Placenta with massive hemorrhage and an extensive retroplacental hematoma.
Source: Author’s documentation

A special form of placental abruption is chronic placental abruption which is characterized by light, occasional bleeding followed by placental insuficiency, olygohidramnios and intrauterine growth restriction [23]. In this case, the delivery ends with a Cesarean section. The newborn has low birthweight for gestational age, whereas maternal general condition is good. Echosonographic examination reveals a retroplacental hematoma with decidua basalis and a partial or complete separation of the placenta followed by massive hemorrhage (Figure 3).

Figure 3. Ultrasound appearance of a retroplacental hematoma in placental abruption. The red arrow points to the retroplacental hematoma revealed by echosonographic examination. Source: Author’s documentation

Figure 3. Ultrasound appearance of a retroplacental hematoma in placental abruption. The red arrow points to the retroplacental hematoma revealed by echosonographic examination.
Source: Author’s documentation

Ultrasound findings can be false negative, especially in fresh, acute bleeding prior to delivery where a retroplacental hematoma has not fully developed. The delivery ends with a Cesarean section, usually with no consequences for either the newborn or the mother [24].

Postpartum, the examination of the placenta can reveal hematomas of various sizes and locations. If a hematoma persists long after the separation from the placenta, a defect on the fetal surface of the placenta occurs (Figure 2). Histopathological examination of the placenta often reveals placental infarction accompanied by a retroplacental hematoma (Figure 4). Apart from this, histopathological findings also serve to diagnose chronic and atypical placental abruption [25].

Figure 4. Histological examination of Class 3 placental abruption (placental tissue preparation microscopic magnification at 10 x). Histopathological examination reveals retroplacental bleeding. In decidua basalis there is a large amount of blood which separates the placental plate, i.e. decidua basalis, from the rest of the uterus, so chorionic villi are immersed into decidua basalis due to the coagulum pressure. Source: Author’s Documentation

Figure 4. Histological examination of Class 3 placental abruption (placental tissue preparation microscopic magnification at 10 x). Histopathological examination reveals retroplacental bleeding. In decidua basalis there is a large amount of blood which separates the placental plate, i.e. decidua basalis, from the rest of the uterus, so chorionic villi are immersed into decidua basalis due to the coagulum pressure.
Source: Author’s Documentation

LABORATORY FINDINGS

Laboratory findings are of crucial importance to the assessment of the coagulation status. Fibrinogen correlates best with the degree of bleeding in pregnant women. Fibrinogen concentration in pregnancy increases with gestational age. Normal fibrinogen level in the third trimester is between 373 and 619 mg/dL [26]. Values below 200 mg/dL indicate mild placental abruption (Class 2). Values over 400 mg/dL indicate that the coagulation status has been preserved [27]. Severe abruption is characterized by a rapid development of dissmeniated intravascular coagulation (DIC) which manifests symptoms of irreversible shock with hypoxia, acidosis and anuria. It starts with the pale skin, cold and sticky sweat, barely detectable and fast pulse, a drop in blood pressure or a complete loss of blood pressure, irregular breathing (alternating shallow breathing with deep breathing), the complete cessation of urine flow, slowing down of blood flow; blood starts coagulating, the brain and the heart do not get enough oxygen [28].

DIC cannot be diagnosed in the laboratory according to a single marker, but a combination of laboratory markers is necessary. Among the four types of DIC, prothrombin (PT), fibrinogen and thrombocytes are important parameters for diagnosing massive bleeding type of DIC, while fibrinogen, fibrin degradation products (FDP) and plasmin-plasmin inhibitor complex are important for detecting the type of DIC bleeding. Meanwhile, thrombocytes, PT and antithrombin (AT) are significant for diagnosing the organ failure type of DIC, whereas hemostatic molecular markers, such as soluble fibrin (SF) and thrombin-antithrombin complex (TAT) are significant for diagnosing the asymptomatic type of DIC [29],[30].

TREATING PLACENTAL ABRUPTION

When treating placental abruption, it is important to consider the gestation of the pregnancy, the clinical picture of abruption and maternal and fetal wellbeing. Termination of pregnancy is necessary in case of perinatal asphyxia or severe abruption, even before corticosteroid therapy is administered. In case of intrauterine fetal death, further procedures are determined according to the maternal status.

A Cesarean section is indicated in hemodynamically unstable patients with massive bleeding. In such cases, the coagulation status is of utmost importance, because uncontrolled disseminated intravascular coagulopathy may endanger the surgical procedure and the life of the mother. If the woman is hemodynamically stable, a vaginal delivery is possible. If the pregnancy is less than 34 weeks gestation, in mild or moderte abruption the pregnancy should be extended using corticosteroids for fetal lung maturation. After the 34th week, termination of pregnancy is recommended except in cases of mildest abruption when delivery can be delayed until the 37th week [31].

The use of tocolytics is debatable and is constantly discussed in connection with the reduction of contractions or subsequent intensified bleeding. Some authors state that the use of tocolytics extend the duration of pregnancy with the possibility of heavier bleeding in the third trimester, which would justify the use of tocolytics, especially Nifedipine as a medication of first choice. On the other hand, the negative effect of tocolytics on the cardiovascular system, as well as tachycardia and hypotension, can mask the symptoms, to worsen abruption and provoke additional hemodynamic instability. What follows from all the above mentioned is that the application of tocolytics depends on clinicians’ individual assessment. If the degree of separation allows, it is best to extend the pregnancy and opt for a vaginal delivery [32].

THE IMPORTANCE OF EARLY RECOGNITION AND TIMELY MANAGEMENT

Neonatal mortality and morbidity may be caused by the presence of abruption and the problems related to premature birth. The very act of premature birth brings a series of complications in the newborn – asphyxia, respiratory distress syndrome, immature organ systems, the need for mechanical ventilation, apneic crises, convulsions, intracranial hemorrhage – which leads to cerebral damage in extremely immature newborns and in some cases even to a fatal outcome [33].

Preterm birth (just like emergency Cesarean section) delays the colonization of the newborn’s intestinal flora with gut bacteria from the birth canal and the development of intestinal microbiota which are necessary for the development of the newborn’s immunity immediately after birth and later in life through the inherited immune response for the development of the brain and which can improve neurological outcomes in preterm children [34], similarly to ‘skin-to-skin’ contact between the mother and the newborn, which is necessary for establishing emotional contact with the mother [35].

Colonization of the gastrointestinal tract and the skin of preterm children begins in the womb. The composition of the gut and skin microbiota affects the development of the innate immune response, including the development of necrotizing enterocolitis and early-onset and late-onset neonatal sepsis [36], thereby preventing premature mortality during intensive care unit stays. It is assumed that bacterial colonization of the intestine at birth and postnatal intestinal dysbiosis precede the development of necrotizing enterocolitis and sepsis in extremely immature preterms (birth weight below 1500g) who are associated with mortlity rate of up to 15% [37].

CONCLUSION

Considering the fact that the severity of maternal clinical picture and fetal distress correlate with the degree of placental separation, placental abruption is an emergency which requires prompt diagnosis and adequate treatment. In almost complete or complete abruption, fetal death can be prevented by emergency Cesarien delivery.

  • Conflict of interest:
    None declared.

Informations

Volume 3 No 4

December 2023

Pages 446-454
  • Keywords:
    pregnancy, abruptio placentae, delivery, newborn
  • Received:
    28 March 2022
  • Revised:
    21 April 2022
  • Accepted:
    03 November 2022
  • Online first:
    25 December 2022
  • DOI:
  • Cite this article:
    Babić S, Jovandarić MZ. The main features of placental abruption: Clinical presentation and treatment. Serbian Journal of the Medical Chamber. 2022;3(4):446-54. doi: 10.5937/smclk3-37202
Corresponding author

Sandra Babić
Department of Fertility Control, Clinic for Gynecology and Obstetrics,
University Clinical Center of Serbia
26 Visegradska Street, 11000 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.



REFERENCES

1. DesJardin JT, Healy MJ, Nah G, Vittinghoff E, Agarwal A, Marcus GM, Velez JMG, Tseng ZH, Parikh NI. Placental abruption as a risk factor for heart failure. Am J Cardiol. 2020 ;131:17-22 [CROSSREF]

2. Odendaal H, Wright C, Schubert P, Boyd TK, Roberts Đ, Brink L, Nel D, Groenewald C. Associations of maternal smoking and drinking with fetal growth and placental abruption. Eur J Obstet Gynecol Reprod Biol. 2020; 253:95-102. [CROSSREF]

3. Tikkanen, M. Placental abruption: Epidemiology, risk factors and consequences. Acta Obstet. Gynecol. Scand. 2011; 90: 140–9. [CROSSREF]

4. Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption–Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center. Int. J. Environ. Res. Public Health 2022; 19: 5148 [CROSSREF]

5. Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, Biggio J, Williams MA, Wapner RJ, Wright JD. Severe placental abruption: clinical definition and associations with maternal complications.Am J Obstet Gynecol. 2016 ;214:272.e1-272.e9 [CROSSREF]

6. Mei Y, Lin Y. Clinical significance of primary symptoms in women with placental abruption.J Matern Fetal Neonatal Med. 2018 ;31:2446-9 [CROSSREF]

7. Long SY, Yang Q, Chi R, Luo L, Xiong X, Chen ZQ. Maternal and Neonatal Outcomes Resulting from Antepartum Hemorrhage in Women with Placenta Previa and Its Associated Risk Factors: A Single-Center Retrospective Study. Ther Clin Risk Manag. 2021;17:31-8 [CROSSREF]

8. Martinelli KG, Garcia ÉM, Santos Neto ETD, Gama SGND. Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis. Cad Saude Publica. 2018; 34:e00206116. [CROSSREF]

9. Ott J, Pecnik P, Promberger R, Pils S, Binder J, Chalubinski KM. Intra- versus retroplacental hematomas: a retrospective case-control study on pregnancy outcomes. BMC Pregnancy Childbirth;17:366. [CROSSREF]

10. Levy M, Gonen N, Kovo M, Schreiber L, Marom O, Barda G, Volpert E, Bar J, Weiner E. Does macroscopic estimation of the extent of placental abruption correlate with pregnancy outcomes? Eur J Obstet Gynecol Reprod Biol. 2020; 254:188-94. [CROSSREF]

11. Barua S, Chakrabarty A, Samanta A, Naskar A. Evaluation of Maternal and Fetal Outcome in Patients of Abruptio Placentae in a Tertiary Care Center, Kolkata: A Descriptive and Observational Study. Asian J Med Sci 2022; 13: 208-13. [CROSSREF]

12. Rasmussen S, Ebbing C, Linde LE, Baghestan E. Placental abruption in parents who were born small: registry-based cohort study. BJOG. 2018; 125:667-74. [CROSSREF]

13. Qiu Y, Wu L, Xiao Y, Zhang X. Clinical analysis and classification of placental abruption.J Matern Fetal Neonatal Med. 2021 ;34:2952-6. [CROSSREF]

14. Schmidt P, Skelly CL, Raines DA. Placental Abruption. [Updated 2022 Apr 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482335/ [HTTP]

15. Yang Li, Yuan Tian, Ning Liu, Yang Chen, Fuju Wu. Analysis of 62 placental abruption cases: Risk factors and clinical outcomes, Taiwanese Journal of Obstetrics and Gynecology, 2019; 58 :223-6. [CROSSREF]

16. Lier H, Bernhard M, Hossfeld B. [Hypovolemic and hemorrhagic shock].Anaesthesist. 2018;67: 225-44. [CROSSREF]

17. Wada H, Matsumoto T, Yamashita Y.J Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines Intensive Care. 2014; 2:15. [CROSSREF]

18. Couvelaire A. Deux nouvelles observations d’apoplexie utero-placentaire (hemorrhagies retro-placentaires avec inltration sanguine de la pavoi musculaire del’uterus). Ann Gynecol Obstet 1912; 9:486.

19. Dashraath P, Wong YC. Couvelaire Uterus. N Engl J Med. 2020; 383:1973. doi:10.1056/NEJMicm2010749. [CROSSREF]

20. Yi Jia Lee, Katrina Calvert, Kedar Jape, Couvelaire uterus resulting in haemoperitoneum, Journal of Surgical Case Reports 2022;1:rjab618, https://doi.org/10.1093/jscr/rjab618 [CROSSREF]

21. Naidu H, Pai MV. Cervical traction: A simple step ahead in the prevention of postpartum hemorrhage. Int J Reprod Contracept Obstet Gynecol. 2019;8: 3174-8. [CROSSREF]

22. Hill MG, Reed KL, Brown RN; Newborn Brain Society Guidelines and Publications Committee. Perinatal asphyxia from the obstetric standpoint. Semin Fetal Neonatal Med. 2021; 26:101259. [CROSSREF]

23. Han CS, Schatz F, Lockwood CJ. Abruption-associated prematurity.Clin Perinatol. 2011; 38:407-21. [CROSSREF]

24. Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage-review of imaging appearance. Am J Perinatol. 2017; 34:935-57.

25. Eubanks AA, Walz S, Thiel LM. Maternal risk factors and neonatal outcomes in placental abruption among patients with equal access to health care. J Matern Fetal Neonatal Med. 2021; 34:2101-6. [CROSSREF]

26. Wang L, Matsunaga S, Mikami Y, Takai Y, Terui K, Seki H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption.J Obstet Gynaecol Res. 2016 ;42:796-802. [CROSSREF]

27. Su J, Yang Y, Cao Y, Yin Z. The predictive value of pre-delivery laboratory test results for the severity of placental abruption and pregnancy outcome. Placenta. 2021; 103:220-5. [CROSSREF]

28. Asakura H. [DIC: state-of-the-art in diagnosis and management]. Rinsho Ketsueki. 2019; 60:659-66.

29. Wada H, Matsumoto T, Aota T, Yamashita Y. [Progress in diagnosis and treatment for disseminated intravascular coagulation]. Rinsho Ketsueki. 2015; 56:169-76.

30. Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments.J Blood Med. 2022 ;13:21-44. [CROSSREF]

31. Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D, Daskalakis G. Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis. Am J Obstet Gynecol. 2020; 223:525-37. [CROSSREF]

32. Kojima T, Takami M, Shindo R, Saigusa Y, Miyagi E, Aoki S. Perinatal outcomes of recurrent placental abruption.J Matern Fetal Neonatal Med. 2021 ;34:2192-6. [CROSSREF]

33. Jovandaric MZ. The Effect of Abruptio Placentae on Perinatal Outcome of Pregnancy. J Clin Case Rep 2016; 6: 775. [CROSSREF]

34. Lu J, Claud EC. Connection between gut microbiome and brain development in preterm infants.Dev Psychobiol. 2019; 61:739-51. [CROSSREF]

35. Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Geneva: World Health Organization; 2013. 11, POSTNATAL CARE OF THE MOTHER AND NEWBORN. Available from: https://www.ncbi.nlm.nih.gov/books/NBK304191/ [HTTP]

36. Underwood MA, Sohn K. The Microbiota of the Extremely Preterm Infant. Clin Perinatol. 2017; 44:407-27. [CROSSREF]

37. Lee JK, Hern Tan LT, Ramadas A, Ab Mutalib NS, Lee LH. Exploring the Role of Gut Bacteria in Health and Disease in Preterm Neonates. Int J Environ Res Public Health. 2020; 17:6963. [CROSSREF]

1. DesJardin JT, Healy MJ, Nah G, Vittinghoff E, Agarwal A, Marcus GM, Velez JMG, Tseng ZH, Parikh NI. Placental abruption as a risk factor for heart failure. Am J Cardiol. 2020 ;131:17-22 [CROSSREF]

2. Odendaal H, Wright C, Schubert P, Boyd TK, Roberts Đ, Brink L, Nel D, Groenewald C. Associations of maternal smoking and drinking with fetal growth and placental abruption. Eur J Obstet Gynecol Reprod Biol. 2020; 253:95-102. [CROSSREF]

3. Tikkanen, M. Placental abruption: Epidemiology, risk factors and consequences. Acta Obstet. Gynecol. Scand. 2011; 90: 140–9. [CROSSREF]

4. Bączkowska M, Kosińska-Kaczyńska K, Zgliczyńska M, Brawura-Biskupski-Samaha R, Rebizant B, Ciebiera M. Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption–Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center. Int. J. Environ. Res. Public Health 2022; 19: 5148 [CROSSREF]

5. Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, Biggio J, Williams MA, Wapner RJ, Wright JD. Severe placental abruption: clinical definition and associations with maternal complications.Am J Obstet Gynecol. 2016 ;214:272.e1-272.e9 [CROSSREF]

6. Mei Y, Lin Y. Clinical significance of primary symptoms in women with placental abruption.J Matern Fetal Neonatal Med. 2018 ;31:2446-9 [CROSSREF]

7. Long SY, Yang Q, Chi R, Luo L, Xiong X, Chen ZQ. Maternal and Neonatal Outcomes Resulting from Antepartum Hemorrhage in Women with Placenta Previa and Its Associated Risk Factors: A Single-Center Retrospective Study. Ther Clin Risk Manag. 2021;17:31-8 [CROSSREF]

8. Martinelli KG, Garcia ÉM, Santos Neto ETD, Gama SGND. Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis. Cad Saude Publica. 2018; 34:e00206116. [CROSSREF]

9. Ott J, Pecnik P, Promberger R, Pils S, Binder J, Chalubinski KM. Intra- versus retroplacental hematomas: a retrospective case-control study on pregnancy outcomes. BMC Pregnancy Childbirth;17:366. [CROSSREF]

10. Levy M, Gonen N, Kovo M, Schreiber L, Marom O, Barda G, Volpert E, Bar J, Weiner E. Does macroscopic estimation of the extent of placental abruption correlate with pregnancy outcomes? Eur J Obstet Gynecol Reprod Biol. 2020; 254:188-94. [CROSSREF]

11. Barua S, Chakrabarty A, Samanta A, Naskar A. Evaluation of Maternal and Fetal Outcome in Patients of Abruptio Placentae in a Tertiary Care Center, Kolkata: A Descriptive and Observational Study. Asian J Med Sci 2022; 13: 208-13. [CROSSREF]

12. Rasmussen S, Ebbing C, Linde LE, Baghestan E. Placental abruption in parents who were born small: registry-based cohort study. BJOG. 2018; 125:667-74. [CROSSREF]

13. Qiu Y, Wu L, Xiao Y, Zhang X. Clinical analysis and classification of placental abruption.J Matern Fetal Neonatal Med. 2021 ;34:2952-6. [CROSSREF]

14. Schmidt P, Skelly CL, Raines DA. Placental Abruption. [Updated 2022 Apr 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482335/ [HTTP]

15. Yang Li, Yuan Tian, Ning Liu, Yang Chen, Fuju Wu. Analysis of 62 placental abruption cases: Risk factors and clinical outcomes, Taiwanese Journal of Obstetrics and Gynecology, 2019; 58 :223-6. [CROSSREF]

16. Lier H, Bernhard M, Hossfeld B. [Hypovolemic and hemorrhagic shock].Anaesthesist. 2018;67: 225-44. [CROSSREF]

17. Wada H, Matsumoto T, Yamashita Y.J Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines Intensive Care. 2014; 2:15. [CROSSREF]

18. Couvelaire A. Deux nouvelles observations d’apoplexie utero-placentaire (hemorrhagies retro-placentaires avec inltration sanguine de la pavoi musculaire del’uterus). Ann Gynecol Obstet 1912; 9:486.

19. Dashraath P, Wong YC. Couvelaire Uterus. N Engl J Med. 2020; 383:1973. doi:10.1056/NEJMicm2010749. [CROSSREF]

20. Yi Jia Lee, Katrina Calvert, Kedar Jape, Couvelaire uterus resulting in haemoperitoneum, Journal of Surgical Case Reports 2022;1:rjab618, https://doi.org/10.1093/jscr/rjab618 [CROSSREF]

21. Naidu H, Pai MV. Cervical traction: A simple step ahead in the prevention of postpartum hemorrhage. Int J Reprod Contracept Obstet Gynecol. 2019;8: 3174-8. [CROSSREF]

22. Hill MG, Reed KL, Brown RN; Newborn Brain Society Guidelines and Publications Committee. Perinatal asphyxia from the obstetric standpoint. Semin Fetal Neonatal Med. 2021; 26:101259. [CROSSREF]

23. Han CS, Schatz F, Lockwood CJ. Abruption-associated prematurity.Clin Perinatol. 2011; 38:407-21. [CROSSREF]

24. Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage-review of imaging appearance. Am J Perinatol. 2017; 34:935-57.

25. Eubanks AA, Walz S, Thiel LM. Maternal risk factors and neonatal outcomes in placental abruption among patients with equal access to health care. J Matern Fetal Neonatal Med. 2021; 34:2101-6. [CROSSREF]

26. Wang L, Matsunaga S, Mikami Y, Takai Y, Terui K, Seki H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption.J Obstet Gynaecol Res. 2016 ;42:796-802. [CROSSREF]

27. Su J, Yang Y, Cao Y, Yin Z. The predictive value of pre-delivery laboratory test results for the severity of placental abruption and pregnancy outcome. Placenta. 2021; 103:220-5. [CROSSREF]

28. Asakura H. [DIC: state-of-the-art in diagnosis and management]. Rinsho Ketsueki. 2019; 60:659-66.

29. Wada H, Matsumoto T, Aota T, Yamashita Y. [Progress in diagnosis and treatment for disseminated intravascular coagulation]. Rinsho Ketsueki. 2015; 56:169-76.

30. Erez O, Othman M, Rabinovich A, Leron E, Gotsch F, Thachil J. DIC in Pregnancy - Pathophysiology, Clinical Characteristics, Diagnostic Scores, and Treatments.J Blood Med. 2022 ;13:21-44. [CROSSREF]

31. Bellos I, Pergialiotis V, Papapanagiotou A, Loutradis D, Daskalakis G. Comparative efficacy and safety of oral antihypertensive agents in pregnant women with chronic hypertension: a network metaanalysis. Am J Obstet Gynecol. 2020; 223:525-37. [CROSSREF]

32. Kojima T, Takami M, Shindo R, Saigusa Y, Miyagi E, Aoki S. Perinatal outcomes of recurrent placental abruption.J Matern Fetal Neonatal Med. 2021 ;34:2192-6. [CROSSREF]

33. Jovandaric MZ. The Effect of Abruptio Placentae on Perinatal Outcome of Pregnancy. J Clin Case Rep 2016; 6: 775. [CROSSREF]

34. Lu J, Claud EC. Connection between gut microbiome and brain development in preterm infants.Dev Psychobiol. 2019; 61:739-51. [CROSSREF]

35. Counselling for Maternal and Newborn Health Care: A Handbook for Building Skills. Geneva: World Health Organization; 2013. 11, POSTNATAL CARE OF THE MOTHER AND NEWBORN. Available from: https://www.ncbi.nlm.nih.gov/books/NBK304191/ [HTTP]

36. Underwood MA, Sohn K. The Microbiota of the Extremely Preterm Infant. Clin Perinatol. 2017; 44:407-27. [CROSSREF]

37. Lee JK, Hern Tan LT, Ramadas A, Ab Mutalib NS, Lee LH. Exploring the Role of Gut Bacteria in Health and Disease in Preterm Neonates. Int J Environ Res Public Health. 2020; 17:6963. [CROSSREF]


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