Ruling Out plасeոtal abruption

Q: Ρlасeոtal abruption can be ruled out if vaginal bleeding is painless.

A) True

B) False

Answer: B

The main differences between placenta previa and placental abruption are the position of the placenta and the symptoms associated with each condition.

Placental abruptio: The placenta is correctly implanted, but the placenta is prematurely separated. It is the separation of the placenta from the inner uterine wall before the baby's delivery. It is also referred to as abruptio placentae and placental abruption. Bleeding is at the decidual-placental interface of the usually implanted placenta, leading to complete or partial detachment of the placenta before delivery of the fetus. This condition is generally associated with uterine pain and tenderness. It can include: 

• Abdominal pain or cramping, 
• Pain that feels like a bruise, 
• Severe or excruciating pain,
• Painful vaginal bleeding, 
• Tetanic uterine contractions,
• Uterine hypertonicity 
• Non-reassuring fetal heart rate pattern.

Placenta previa: The placenta is positioned near or over the cervix, blocking part or all of it. This is also known as a low-lying placenta. Placenta previa usually causes painless vaginal bleeding during the second or third trimester. In other words, the placental tissue is implemented entirely or partially in the lower part of the uterus post-20 weeks of gestation. Here, the abnormally implanted placenta can entirely or partially cover the cervix. Its different types are:

• Low-lying placenta previa, 
• Partial placenta previa, 
• Marginal placenta previa, 
• Total placenta previa 

In other words, the placental tissue is implemented entirely or partially in the lower part of the uterus post-20 weeks of gestation. Here, the abnormally implanted placenta can entirely or partially cover the cervix.

Main Differences between Placenta Previa and Placenta Abruptio: The placenta gets entirely or partially detached from the wall of the uterus before delivery in the case of placenta abruptio. 

Typically, patients with placenta abruptio face painful contractions and bleeding, while those with placenta previa sense painless bleeding - but it's not a differentiating clinical sign.  

Both conditions can cause vaginal bleeding during pregnancy and labor. 

The take-home message is that in рregոаnt patients with vaginal blеeԁiոg, an սltrаѕοuոd examination should be performed quickly to establish the diagnosis. 

#ob-gyn

#differential-diagnosis

References:

1. Brandt JS, Ananth CV. Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management. Am J Obstet Gynecol. 2023 May;228(5S):S1313-S1329. doi: 10.1016/j.ajog.2022.06.059. Epub 2023 Mar 23. PMID: 37164498; PMCID: PMC10176440.

2. Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. 2002 Aug;21(8):837-40. doi: 10.7863/jum.2002.21.8.837. PMID: 12164566.