Acute Placental Abruption Accounts for 37% of Pregnancy-Related Disseminated Intravascular Coagulation (DIC) Cases (J Obstet Gynaecol Can, 2012) [MEDLINE]
Disseminated Intravascular Coagulation (DIC) Occurs in 10–20% of Acute Placental Abruptions with Death of the Fetus (Am J Obstet Gynecol, 2016) [MEDLINE]
Coagulation Defects Can develop Rapidly (within Minutes-Hours)
Diagnosis
Laboratory Findings Generally Correlate with the Degree of Placental Separation
A Small Degree of Placental Separation May Not Be Associated with Any Hemostatic Laboratory Abnormalities, Whereas >50% Placental Separation Can Result in Disseminated Intravascular Coagulation (DIC)
Reproductive Manifestations
Uterine Contractions
Clinical
Uterus is Often Firm (May Be Rigid and Tender)
Contractions are Typically High-Frequency, Low-Amplitude
But May Be a Typical Labor Pattern in Some Cases (with Rapid Progression of Labor)
Vaginal Bleeding
Clinical
In 80–90% of Cases, Vaginal Bleeding is Typically Abrupt in Onset
However, the Amount of Vaginal Bleeding Correlates Poorly with the Degree of Placenal Separation
Since a Large Volume of Blood May Be Retained Behind the Placenta
In 10–20% of Cases (“Concealed Abruption”), Patient Presents with Minimal/No Vaginal Bleeding, Absence of Abdominal Pain, and Presence of Isolated Uterine Contractions/Irritability
In These Cases, Most or All of the Blood is Trapped Between the Fetal Membranes and Decidua Rather than Escaping Via the Cervix and Vagina
Nonreassuring Fetal Heart Rate Pattern May Be Present
In a Few Cases, Patient May Be Asymptomatic (with Incidental Recognition on Ultrasound)
May Occur in Cases when the Placenta is on the Posterior Wall of the Uterus
Treatment
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References
General
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Clinical
Acute disseminated intravascular coagulation in obstetrics: a tertiary centre population review (1980 to 2009). J Obstet Gynaecol Can. 2012 Apr;34(4):341–7 [MEDLINE]
An update on the use of massive transfusion protocols in obstetrics. Am J Obstet Gynecol. 2016;214(3):340 [MEDLINE]
