Placenta
Nonneoplastic placental conditions and abnormalities
Noninfectious
Retroplacental hematoma with intraplacental extension (abruption)


Topic Completed: 1 October 2011

Minor changes: 29 October 2020

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PubMed Search: Retroplacental hematoma abruption

Mandolin S. Ziadie, M.D.
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Cite this page: Ziadie MS. Retroplacental hematoma with intraplacental extension (abruption). PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/placentaretroplacentalhematoma.html. Accessed May 7th, 2021.
Definition / general
  • Hematomas between the basal plate and uterus form due to acute or chronic hemorrhage; if significant ( > 50%), there is an increased risk of fetal death
  • Smaller hematomas pose a risk for vaginal bleeding, oligohydramnios and premature delivery
  • Diagnosis of abruption is clinical; findings in the placenta may not be sufficient
  • Kleihauer-Betke test for fetal maternal hemorrhage is NOT recommended for diagnosis (Arch Pathol Lab Med 1995;119:1032)
  • Breus mole: massive subchorionic hematoma that can lead to diminished placental function and intrauterine death; sometimes identified on ultrasound (Arch Pathol Lab Med 1983;107:438)
Etiology
  • Breus mole: chronic hemorrhage into the subchorionic space that is seen in both live births and missed abortions
Diagrams / tables

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Diagram

Gross description
  • Loose blood clots or blood clots tenuously adherent to placental floor if acute
  • Remote episodes have brown tan, old fibrin and necrotic tissue at abruption site and adjacent membranous tissue
  • Features of intraplacental extension include pale areas of infarction
  • Breus mole: nodular hematoma on fetal surface that bulges into the amnionic cavity and distorts the underlying parenchyma; overlying membranes may be discolored due to hemosiderin
Gross images

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Abruptio placenta with dark red retroplacental blood clot

Microscopic (histologic) description
  • Retroplacental hemorrhage or hematomas associated with diffuse intradecidual hemorrhage, villous stromal hemorrhage / edema, intervillous thrombi or infarction
  • Chronic hemorrhage may also show hemosiderin staining
Microscopic (histologic) images

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Extensive hemorrhage

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