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What is retroplacental hematoma?

Retroplacental hematoma is a pocket of blood clot that accumulates between the basal plate of the placenta and the wall of uterus, causing the placenta to bulge toward the uterine wall into the peritoneal cavity. This in effect may compress the structures and compromise the blood supply to the fetus. Retroplacental hematoma represents one of the most common causes of perinatal mortality (85%) due to placental infarcation.

Causes of retroplacental hematoma

The most common cause of retroplacental hematoma is a ruptured maternal artery leading to a high-pressure hemorrhage, therefore it is closely related to hypertension and vascular disease. Risk factors include smoking, advanced maternal age, acute chorioamnionitis, and cocaine abuse.

Physiology of retroplacental hematoma

Sonographically, the retroplacental hematoma may be akin to a thickened placenta because the hematoma is commonly isoechoic to the placenta. Otherwise, the retroplacental hematoma may be hypoechoic or may be of heterogeneous echogenicity. Because of the low sensitivity of sonography in detecting small retroplacental or submembranous hematomas or the occasional absence of bleeding with placental abruption, negative sonographic findings do not rule out the presence of placental abruption.

Signs and symptoms of retroplacental hematoma

Retroplacental hematomas can manifest as clinical condition of placental abruption (abruptio placentae) — a premature separation of the placenta from the uterus characterized by painful vaginal bleeding, uterine tetany, fetal distress and sometimes consumption cagulopathy. The vaginal hemorrhage typically occurs with large retroplacental hematomas once the peripheral margins of the placenta are disrupted and the placental membranes are stripped from the underlying basal plate (decidua basalis). It is a life-threatening obstetrical emergency. In near-complete or complete abruption, fetal death is inevitable unless an immediate cesarian delivery is performed.

In cases involving a smaller sized hematoma, however, there may be no outward symptoms.

Prognosis of retroplacental hematoma

Retroplacental hematoma is a sudden event with a grave prognosis. Smaller hematomas have larger impact on early gestations (the first trimester of pregnancy). In late pregnancy large hematomas must strip more than 30-40% of placenta away from myometrium to have clinical implications. Retroplacental hematomas tend to decrease in size with age of pregnancy, although rate of decrease is variable.