Retroplacental Haemorrhage and Marginal Haemorrhage

  • Robert W. Bendon


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.


Retroplacental haemorrhage Placental abruption Premature separation 


  1. 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.CrossRefGoogle Scholar
  2. 2.
    Page EW, King EB, Merrill JA. Abruptio placentae; dangers of delay in delivery. Obstet Gynecol. 1954;3:385–93.PubMedGoogle Scholar
  3. 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. 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.PubMedGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 6.
    Abdella TN, Sibai BM, Hays JM Jr, Anderson GD. Relationship of hypertensive disease to abruptio placentae. Obstet Gynecol. 1984;63:365–70.PubMedGoogle Scholar
  7. 7.
    Kramer MS, Usher RH, Pollack R, Boyd M, Usher S. Etiologic determinants of abruptio placentae. Obstet Gynecol. 1997;89:221–6.CrossRefGoogle Scholar
  8. 8.
    Bendon RW. Review of autopsies of stillborn infants with retroplacental hematoma or hemorrhage. Pediatr Dev Pathol. 2011;14:10–5.CrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Hibbard BM. The role of folic acid in pregnancy. J Obstet Gynaecol Br Commonw. 1964;71:529–42.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 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. e1–7PubMedPubMedCentralGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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. e1–8CrossRefGoogle Scholar
  23. 23.
    Fretts RC, Boyd ME, Usher RH, Usher HA. The changing pattern of fetal death, 1961–1988. Obstet Gynecol. 1992;79:35–9.PubMedGoogle Scholar
  24. 24.
    Golditch IM, Boyce NE Jr. Management of abruptio placentae. JAMA. 1970;212:288–93.CrossRefGoogle Scholar
  25. 25.
    Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA. 1999;282:1646–51.CrossRefGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. 27.
    Gilabert J, Estelles A, Aznar J, Galbis M. Abruptio placentae and disseminated intravascular coagulation. Acta Obstet Gynecol Scand. 1985;64:35–9.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 30.
    Fries MH, Hankins GD. Motor vehicle accident associated with minimal maternal trauma but subsequent fetal demise. Ann Emerg Med. 1989;18:301–4.CrossRefGoogle Scholar
  31. 31.
    Kettel LM, Branch DW, Scott JR. Occult placental abruption after maternal trauma. Obstet Gynecol. 1988;71:449–53.PubMedGoogle Scholar
  32. 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 7-10CrossRefGoogle Scholar
  33. 33.
    Stafford PA, Biddinger PW, Zumwalt RE. Lethal intrauterine fetal trauma. Am J Obstet Gynecol. 1988;159:485–9.CrossRefGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. 36.
    Hulse GK, Milne E, English DR, Holman CD. Assessing the relationship between maternal cocaine use and abruptio placentae. Addiction. 1997;92:1547–51.CrossRefGoogle Scholar
  37. 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. 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.CrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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. e1–5PubMedPubMedCentralGoogle Scholar
  41. 41.
    Acker D, Sachs BP, Tracey KJ, Wise WE. Abruptio placentae associated with cocaine use. Am J Obstet Gynecol. 1983;146:220–1.CrossRefGoogle Scholar
  42. 42.
    Meeker JE, Reynolds PC. Fetal and newborn death associated with maternal cocaine use. J Anal Toxicol. 1990;14:379–82.CrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 44.
    Kerr MG. Clinical implications of inferior vena caval occlusion in pregnancy. Proc R Soc Med. 1964;57:705–6.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Scott DB, Kerr MG. Inferior vena caval pressure in late pregnancy. J Obstet Gynaecol Br Commonw. 1963;70:1044–9.CrossRefGoogle Scholar
  46. 46.
    Ness PM, Budzynski AZ, Olexa SA, Rodvien R. Congenital hypofibrinogenemia and recurrent placental abruption. Obstet Gynecol. 1983;61:519–23.PubMedGoogle Scholar
  47. 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.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Robert W. Bendon
    • 1
  1. 1.Formerly of Norton Children’s HospitalLouisvilleUSA

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