Skip to main content
SpringerLink
Log in

Retroplacental Haemorrhage and Marginal Haemorrhage

  • Chapter
  • First Online:
Pathology of the Placenta

  • 2277 Accesses

Abstract

A premature separation of the placenta results in torn decidual vessels creating a haemorrhage below the placenta and an infarction of the overlying villi. An incomplete separation often results in a haematoma that creates a depression on the maternal surface. The fetus is at risk of asphyxia and death from the sudden, large extent of infarcted placenta. The pathological examination of the placenta can determine (1) the relative extent of the placental separation and (2) an approximation of the duration prior to delivery. The most frequent risk factors are preeclampsia, hypertension, thrombophilia, cocaine and cigarette smoking. Some infrequent mechanisms of premature separation of the placenta are hypocoagulative states, severe pelvic trauma and vena caval compression.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gruenwald P, Levin H, Yousem H. Abruption and premature separation of the placenta. The clinical and the pathologic entity. Am J Obstet Gynecol. 1968;102:604–10.

    Article  CAS  Google Scholar 

  2. Page EW, King EB, Merrill JA. Abruptio placentae; dangers of delay in delivery. Obstet Gynecol. 1954;3:385–93.

    CAS  PubMed  Google Scholar 

  3. Rigby E. An essay on the uterine hemorrhage which precedes the delivery of the full grown fetus. 6th ed. London: Burks and Kinnebrook; 1822.

    Google Scholar 

  4. Saftlas AF, Olson DR, Atrash HK, Rochat R, Rowley D. National trends in the incidence of abruptio placentae, 1979–1987. Obstet Gynecol. 1991;78:1081–6.

    CAS  PubMed  Google Scholar 

  5. Bendon RW, Coventry S, Bendon J, Nordmann A, Schikler K. A follow-up study of lympho-histiocytic villitis and of incidental retroplacental hematoma. Pediatr Dev Pathol. 2014;17:94–101.

    Article  Google Scholar 

  6. Abdella TN, Sibai BM, Hays JM Jr, Anderson GD. Relationship of hypertensive disease to abruptio placentae. Obstet Gynecol. 1984;63:365–70.

    CAS  PubMed  Google Scholar 

  7. Kramer MS, Usher RH, Pollack R, Boyd M, Usher S. Etiologic determinants of abruptio placentae. Obstet Gynecol. 1997;89:221–6.

    Article  CAS  Google Scholar 

  8. Bendon RW. Review of autopsies of stillborn infants with retroplacental hematoma or hemorrhage. Pediatr Dev Pathol. 2011;14:10–5.

    Article  Google Scholar 

  9. Vintzileos A, Campbell W, Nochimson D, Weinbaum P. Preterm premature rupture of the membranes: a risk factor for the development of abruptio placentae. Am J Obstet Gynecol. 1987;156:1235–8.

    Article  CAS  Google Scholar 

  10. Owen EP, Human L, Carolissen AA, Harley EH, Odendaal HJ. Hyperhomocysteinemia--a risk factor for abruptio placentae. J Inherit Metab Dis. 1997;20:359–62.

    Article  CAS  Google Scholar 

  11. de Vries JI, Dekker GA, Huijgens PC, Jakobs C, Blomberg BM, van Geijn HP. Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies. Br J Obstet Gynaecol. 1997;104:1248–54.

    Article  Google Scholar 

  12. Goddijn-Wessel TA, Wouters MG, van de Molen EF, Spuijbroek MD, Steegers-Theunissen RP, Blom HJ, et al. Hyperhomocysteinemia: a risk factor for placental abruption or infarction. Eur J Obstet Gynecol Reprod Biol. 1996;66:23–9.

    Article  CAS  Google Scholar 

  13. Hibbard BM. The role of folic acid in pregnancy. J Obstet Gynaecol Br Commonw. 1964;71:529–42.

    Article  CAS  Google Scholar 

  14. Hibbard BM, Hibbard ED, Hwa TS, Tan P. Abruptio placentae and defective folate metabolism in Singapore women. J Obstet Gynaecol Br Commonw. 1969;76:1003–7.

    Article  CAS  Google Scholar 

  15. Gebhardt GS, Scholtz CL, Hillermann R, Odendaal HJ. Combined heterozygosity for methylenetetrahydrofolate reductase (MTHFR) mutations C677T and A1298C is associated with abruptio placentae but not with intrauterine growth restriction. Eur J Obstet Gynecol Reprod Biol. 2001;97:174–7.

    Article  CAS  Google Scholar 

  16. Ananth CV, Peltier MR, De Marco C, Elsasser DA, Getahun D, Rozen R, et al. Associations between 2 polymorphisms in the methylenetetrahydrofolate reductase gene and placental abruption. Am J Obstet Gynecol. 2007;197:385. e1–7

    PubMed  PubMed Central  Google Scholar 

  17. Ananth CV, Elsasser DA, Kinzler WL, Peltier MR, Getahun D, Leclerc D, et al. Polymorphisms in methionine synthase reductase and betaine-homocysteine S-methyltransferase genes: risk of placental abruption. Mol Genet Metab. 2007;91:104–10.

    Article  CAS  Google Scholar 

  18. Pritchard JA, Cunningham FG, Pritchard SA, Mason RA. On reducing the frequency of severe abruptio placentae. Am J Obstet Gynecol. 1991;165:1345–51.

    Article  CAS  Google Scholar 

  19. Nilsen RM, Vollset SE, Rasmussen SA, Ueland PM, Daltveit AK. Folic acid and multivitamin supplement use and risk of placental abruption: a population-based registry study. Am J Epidemiol. 2008;167:867–74.

    Article  Google Scholar 

  20. Ananth CV, Savitz DA, Williams MA. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Obstet Gynecol. 1996;88:309–18.

    Article  CAS  Google Scholar 

  21. Rasmussen S, Irgens LM, Dalaker K. The effect on the likelihood of further pregnancy of placental abruption and the rate of its recurrence. Br J Obstet Gynaecol. 1997;104:1292–5.

    Article  CAS  Google Scholar 

  22. Ruiter L, Ravelli AC, de Graaf IM, Mol BW, Pajkrt E. Incidence and recurrence rate of placental abruption: a longitudinal linked national cohort study in the Netherlands. Am J Obstet Gynecol. 2015;213:573. e1–8

    Article  Google Scholar 

  23. Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961–1988. Obstet Gynecol. 1992;79:35–9.

    CAS  PubMed  Google Scholar 

  24. Golditch IM, Boyce NE Jr. Management of abruptio placentae. JAMA. 1970;212:288–93.

    Article  CAS  Google Scholar 

  25. Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA. 1999;282:1646–51.

    Article  CAS  Google Scholar 

  26. Morgan MA, Berkowitz KM, Thomas SJ, Reimbold P, Quilligan EJ. Abruptio placentae: perinatal outcome in normotensive and hypertensive patients. Am J Obstet Gynecol. 1994;170:1595–9.

    Article  CAS  Google Scholar 

  27. Gilabert J, Estelles A, Aznar J, Galbis M. Abruptio placentae and disseminated intravascular coagulation. Acta Obstet Gynecol Scand. 1985;64:35–9.

    Article  CAS  Google Scholar 

  28. Aitokallio-Tallberg A, Halmesmaki E. Motor vehicle accident during the second or third trimester of pregnancy. Acta Obstet Gynecol Scand. 1997;76:313–7.

    Article  CAS  Google Scholar 

  29. Rogers FB, Rozycki GS, Osler TM, Shackford SR, Jalbert J, Kirton O, et al. A multi-institutional study of factors associated with fetal death in injured pregnant patients. Arch Surg. 1999;134:1274–7.

    Article  CAS  Google Scholar 

  30. Fries MH, Hankins GD. Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise. Ann Emerg Med. 1989;18:301–4.

    Article  CAS  Google Scholar 

  31. Kettel LM, Branch DW, Scott JR. Occult placental abruption after maternal trauma. Obstet Gynecol. 1988;71:449–53.

    CAS  PubMed  Google Scholar 

  32. Pearlman MD, Tintinallli JE, Lorenz RP. A prospective controlled study of outcome after trauma during pregnancy. Am J Obstet Gynecol. 1990;162:1502–7. discussion 7-10

    Article  CAS  Google Scholar 

  33. Stafford PA, Biddinger PW, Zumwalt RE. Lethal intrauterine fetal trauma. Am J Obstet Gynecol. 1988;159:485–9.

    Article  CAS  Google Scholar 

  34. Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematomas detected in the first trimester of pregnancy. Obstet Gynecol. 2003;102:94–100.

    PubMed  Google Scholar 

  35. Witlin AG, Saade GR, Mattar F, Sibai BM. Risk factors for abruptio placentae and eclampsia: analysis of 445 consecutively managed women with severe preeclampsia and eclampsia. Am J Obstet Gynecol. 1999;180:1322–9.

    Article  CAS  Google Scholar 

  36. Hulse GK, Milne E, English DR, Holman CD. Assessing the relationship between maternal cocaine use and abruptio placentae. Addiction. 1997;92:1547–51.

    Article  CAS  Google Scholar 

  37. Naeye RL. Disorders of the placenta, fetus and neonate: diagnosis and clinical significance. St Louis: Mosby Year Book; 1992. p. 375.

    Google Scholar 

  38. Spinillo A, Capuzzo E, Colonna L, Solerte L, Nicola S, Guaschino S. Factors associated with abruptio placentae in preterm deliveries. Acta Obstet Gynecol Scand. 1994;73:307–12.

    Article  CAS  Google Scholar 

  39. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol. 1996;144:881–9.

    Article  CAS  Google Scholar 

  40. Kaminsky LM, Ananth CV, Prasad V, Nath C, Vintzileos AM. The influence of maternal cigarette smoking on placental pathology in pregnancies complicated by abruption. Am J Obstet Gynecol. 2007;197:275. e1–5

    PubMed  PubMed Central  Google Scholar 

  41. Acker D, Sachs BP, Tracey KJ, Wise WE. Abruptio placentae associated with cocaine use. Am J Obstet Gynecol. 1983;146:220–1.

    Article  CAS  Google Scholar 

  42. Meeker JE, Reynolds PC. Fetal and newborn death associated with maternal cocaine use. J Anal Toxicol. 1990;14:379–82.

    Article  CAS  Google Scholar 

  43. Mengert WF, Goodson JH, Campbell RG, Haynes DM. Observations on the pathogenesis of premature separation of the normally implanted placenta. Am J Obstet Gynecol. 1953;66:1104–12.

    Article  CAS  Google Scholar 

  44. Kerr MG. Clinical implications of inferior vena caval occlusion in pregnancy. Proc R Soc Med. 1964;57:705–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Scott DB, Kerr MG. Inferior vena caval pressure in late pregnancy. J Obstet Gynaecol Br Commonw. 1963;70:1044–9.

    Article  CAS  Google Scholar 

  46. Ness PM, Budzynski AZ, Olexa SA, Rodvien R. Congenital hypofibrinogenemia and recurrent placental abruption. Obstet Gynecol. 1983;61:519–23.

    CAS  PubMed  Google Scholar 

  47. Zugaib M, de Barros AC, Bittar RE, Burdmann EA, Neme B. Abruptio placentae following snake bite. Am J Obstet Gynecol. 1985;151:754–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Formerly of Norton Children’s Hospital, Louisville, KY, USA

    Robert W. Bendon

Authors
  1. Robert W. Bendon
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Anatomical Pathology, Women’s and Children’s Hospital, North Adelaide, SA, Australia

    T. Yee Khong

  2. Department of Pathology and Laboratory Medicine, National Maternity Hospital, Dublin, Ireland

    Eoghan E. Mooney

  3. Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands

    Peter G. J. Nikkels

  4. Department of Pathology, Oregon Health and Science University, Portland, OR, USA

    Terry K. Morgan

  5. Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    Sanne J. Gordijn

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bendon, R.W. (2019). Retroplacental Haemorrhage and Marginal Haemorrhage. In: Khong, T., Mooney, E., Nikkels, P., Morgan, T., Gordijn, S. (eds) Pathology of the Placenta. Springer, Cham. https://doi.org/10.1007/978-3-319-97214-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97214-5_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97213-8

  • Online ISBN: 978-3-319-97214-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation