Abruptio placentae is characterised by all except

1-tenderness over the uterus 
2-profuse vaginal bleeding 
3-hypotension 
4-absence of feral heart sound 


Ans: C 

William Obs. 22nd edi. Says- 
Neither hypotension nor anemia is obligatory in cases of concealed hemorrhage, even when the acute hemorrhage has achieved considerable magnitude. 



The separation of the placenta from its site of implantation before delivery has been variously called placental abruption, abruptio placentae, and in Great Britain, accidental hemorrhage.

Some of the bleeding of placental abruption usually insinuates itself between the membranes and uterus, and then escapes through the cervix, causing external hemorrhage. Less often, the blood does not escape externally but is retained between the detached placenta and the uterus, leading to concealed hemorrhage.

The primary cause of placental abruption is unknown, but there are several associated conditions. By far the most commonly associated condition is some type of hypertension. This includes preeclampsia, gestational hypertension, and chronic hypertension.

-There is an increased incidence of abruption with preterm prematurely ruptured membranes.
-Cocaine abuse has been associated with an alarming frequency of placental abruption.
-There is a significantly increased risk of abruption in women with a factor V Leiden or prothrombin gene mutation.
-Abruption caused by relatively minor trauma may cause fetal jeopardy that is not always associated with immediate evidence of placental separation.
-Uterine leiomyomas, especially if located behind the placental implantation site, predispose to abruption

Placental abruption is initiated by hemorrhage into the decidua basalis. The decidua then splits, leaving a thin layer adherent to the myometrium. Consequently, the process in its earliest stages consists of the development of a decidual hematoma that leads to separation, compression, and the ultimate destruction of the placenta adjacent to it.

In some instances, a decidual spiral artery ruptures to cause a retroplacental hematoma, which as it expands disrupts more vessels to separate more placenta. The area of separation rapidly becomes more extensive and reaches the margin of the placenta.

Because the uterus is still distended by the products of conception, it is unable to contract sufficiently to compress the torn vessels that supply the placental site. The escaping blood may dissect the membranes from the uterine wall and eventually appear externally or may be completely retained within the uterus