Placental abruption: a persisting killer

Shakuntala Amirchand Chhabra, V. Pandit, M. Gosavi


Background: Placental abruption, common disorder in obstetric practice, enigma too, is uniquely fraught with dangers to mother baby. Objectives of study were to study trends of placental abruption, risk factors, management strategies to learn more for reduction in morbidity-mortality of mother-baby, even with low resources, also get insight for future research.  

Methods: Records of cases of placental abruption managed over 27 years (between 1985 to 2011) were divided into three yearly blocks, A to I and analysed. Details  including operative procedures like dilatation-curettage, Caesarean Section (CS) or Ante-Partum Haemorrhage (APH) in past, disorders like chronic hypertension, threatened abortion, pregnancy specific hypertension, diabetes, anaemia in index pregnancy, management done maternal-neonatal outcome were analysed using stata 6 software.

Results: There were 66,459 births during analysis period with 667 cases of placental abruption, 1% births, increasing trends from, 0.73% between 1985-1987 to, 1.11% in 2009-2011. In these 667 cases of placental abruption, 211 (32.5%) perinatal deaths occurred. Ratio of perinatal deaths due to placental abruption to overall perinatal deaths increased from 2.12% (8 cases) between 1985-1987 (Block A) to 5.12% (37 cases) between 2009-2011 (Block I). Case fatality in cases of placental abruption has been fluctuating between 3 to 5% till 2004, contributing to around 12-15%, maternal mortality, with no fatality in last 7 years.

Conclusions: Cases of placental abruption have been increasing with no obvious reason. In recent past maternal deaths could be prevented but perinatal deaths, have been persisting actually more in last decade.


Placental Abruption, Perinatal deaths, Maternal deaths

Full Text:



Ananth CV, Smulian JC, Demissie K, Vintzileos AM, Knuppel RA. Placental abruption among singleton and twin births in the United States: risk factor profiles. Am J Epidemiol. 2001;153(8):771-8.

Konje J, Taylor D. Bleeding in later pregnancy. In: James D, Steer P, Weiner C, Gonik B, eds. High Risk Pregnancy. 3rd ed. Philadelphia: Pennsylvania; 2006: 1266-1271.

Pariente G, Wiznitzer A, Sergienko R, Mazor M, Holcberg G, Sheiner E. Placental abruption: critical analysis of risk factors and perinatal outcomes. J Matern Fetal Neonatal Med. 2011;24(5):698-702.

Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynaecol Scand. 2011;90(2):140-9.

Hemminki E, Glebatis DM, Therriault GD, Janerich DT. Incidence of placenta previa and abruptio placentae in New York State. NY State J Med. 1987;87(11):594-8.

Nayama M, Tamakloe-Azamesu D, Garba M, Idi N, Djibril B, Kamaye M et al. Abruptio placentae. Management in a reference Nigerien maternity. Prospective study about 118 cases during one year. Gynaecol Obstet Fertil. 2007;35(10):975-81.

Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A. Risk factors for intrapartum foetal death and trends over the years. Arch Gynaecol Obstet. 2012;285(2):323-9.

Morgan MA, Berkowitz KM, Thomas SJ, Reimbold P, Quilligan EJ. Abruptio placentae: perinatal outcome in normotensive and hypertensive patients. Am J Obstet Gynaecol. 1994 Jun;170(6):1595-9.

Witlin AG, Sibai BM. Perinatal and maternal outcome following abruptio placentae. Hypertens Pregnancy. 2001;20(2):195-203.

Furukawa S, Sameshima H, Ikenoue T, Ohashi M, Nagai Y. Is the perinatal outcome of placental abruption modified by clinical presentation? J Pregnancy. 2011;2011:659615.

Tikkanen M, Gissler M, Metsaranta M, Luukkaala T, Hiilesmaa V, Andersson S et al. Maternal deaths in Finland: focus on placental abruption. Acta Obstet Gynaecol Scand. 2009;88(10):1124-7.

Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979 through 2001: temporal trends and potential determinants. Am J Obstet Gynaecol. 2005 Jan;192(1):191-8.

Sheiner E, Shoham-Vardi I, Hadar A, Hallak M, Hackmon R, Mazor M. Incidence, obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis. J Matern Fetal Neonatal Med. 2002 Jan;11(1):34-9.

Sheiner E, Shoham-Vardi I, Hallak M, Hadar A, Gortzak-Uzan L, Katz M et al. Placental abruption in term pregnancies: clinical significance and obstetric risk factors. J Matern Fetal Neonatal Med. 2003 Jan;13(1):45-9.

Abu-Heija A, al-Chalabi H, el-Iloubani N. Abruptio placentae: risk factors and perinatal outcome. J Obstet Gynaecol Res. 1998 Apr;24(2):141-4.

Oyelese Y, Ananth CV. Placental abruption. Obstet Gynaecol. 2006 Oct;108(4):1005-16.

Ananth CV, Smulian JC, Vintzileos AM. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. Obstet Gynaecol. 1999 Apr;93(4):622-8.

Keyes LE, Armaza JF, Niermeyer S, Vargas E, Young DA, Moore LG. Intrauterine growth restriction, preeclampsia, and intrauterine mortality at high altitude in Bolivia. Paediatr Res. 2003 Jul;54(1):20-5.

Browne VA, Toledo-Jaldin L, Davila RD, Lopez LP, Yamashiro H, Cioffi-Ragan D et al. High-end arteriolar resistance limits uterine artery blood flow and restricts fetal growth in preeclampsia and gestational hypertension at high altitude. Am J Physiol Regul Integr Comp Physiol. 2011;300(5):R1221-9.

Kramer MS, Usher RH, Pollack R, Boyd M, Usher S. Etiologic determinants of abruptio placentae. Obstet Gynaecol. 1997;89(2):221-6.

Ananth CV, Wilcox AJ, Savitz DA, Bowes WA, Jr., Luther ER. Effect of maternal age and parity on the risk of uteroplacental bleeding disorders in pregnancy. Obstet Gynaecol. 1996;88(4 Pt 1):511-6.

Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O. Prepregnancy risk factors for placental abruption. Acta Obstet Gynaecol Scand. 2006;85(1):40-4.

Salihu HM, Bekan B, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR. Perinatal mortality associated with abruptio placenta in singletons and multiples. Am J Obstet Gynaecol. 2005;193(1):198-203.

Rana A, Sawhney H, Gopalan S, Panigrahi D, Nijhawan R. Abruptio placentae and chorioamnionitis-microbiological and histologic correlation. Acta Obstet Gynaecol Scand. 1999;78(5):363-6.

Chang YL, Chang SD, Cheng PJ. Perinatal outcome in patients with placental abruption with and without antepartum hemorrhage. Int J Gynaecol Obstet. 2001;75(2):193-4.