Placental abruption in the exam

Getting a film with placental abruption (premature separation of placenta from uterus) in the exam is one of the many exam set-pieces that can be prepared for. 

Transabdominal and transvaginal pelvic ultrasound show a single live fetus with gestational age of 27 weeks. The cervix is long and closed and the amniotic fluid volume is normal.  There is a posterior placenta that is clear of the os. Adjacent to placenta there is a moderated sized, crescentic hypoechoic collection that extends to and lifts a small portion of the placenta edge up. There is a fluid level within the collection and no vascularity is seen on colour Doppler. The findings are in keeping with a subacute marginal placental abruption.

Both ovaries are normal and no adnexal masses seen. I will plot the fetal biometry on a normalised chart to asses for IUGR and arrange follow up scan. I will inform the obstetrician as they may want to admit the patient for bed rest and observation.

  • 80% present with vaginal bleeding
  • 70% present with pain
  • 20% asymptomatic (concealed)
  • may be marginal (most common type: 67% of cases over 20 weeks gestation), retroplacental, preplacental (rare)
  • variable size but often crescentic
  • if more than 50% detachment leads to greater than 50% fetal death rate
  • need to start screening a patient with previous abruption 6 weeks before the gestational age of the previous haemorrhage
Share article

Article information

rID: 22951
Section: Approach
Synonyms or Alternate Spellings:

Support Radiopaedia and see fewer ads

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.