The incidence of abruption increases with maternal age.

In the First- and Second-Trimester Evaluation of Risk (FASTER) trial, women older
than 40 years were 2.3 times more likely to experience abruption compared with
those 35 years or younger (Cleary-Goldman, 2005).
There are conflicting data regarding women of great parity (Pritchard, 1991;
Toohey, 1995).
Race or ethnicity also appears to be important. In almost 366,000 deliveries at
Parkland Hospital, abruption severe enough to kill the fetus was most common in
African-American and white women1 in 200less so in Asian women1 in 300and
least in Latin-American women1 in 350 (Pritchard, 1991).
 If a woman had a severe abruption, then the risk for her sister was doubled, and the
heritability risk was estimated to be 16 percent.
The control group of their sisters-in-law had a risk similar to that for the general
obstetrical population.
 Some form of hypertension is the most frequent condition associated with placental
abruption.
This includes gestational hypertension, preeclampsia, chronic hypertension, or a
combination thereof.
Risk estimates by Zetterstrom and associates (2005) included a twofold increased
incidence of abruption in women with chronic hypertension compared with
normotensive womenan incidence of 1.1 versus 0.5 percent.
 Chronic hypertension with superimposed preeclampsia or fetal growth restriction
confers an ever greater increased risk (Ananth,2007).
Even so, the severity of hypertension does not necessarily correlate with abruption
incidence (Zetterstrom, 2005).
The longterm effects of these associations are apparent from the significantly
increased cardiovascular mortality risk in affected women (Pariente, 2013).
Observations from the Magpie Trial Collaborative Group (2002) suggest that women
with preeclampsia given magnesium sulfate may have a reduced risk for abruption.
 There is no doubt that there is a substantially increased risk for abruption when the
membranes rupture before term.
Major and colleagues (1995) reported that 5 percent of 756 women with ruptured
membranes between 20 and 36 weeks developed an abruption.
Kramer and coworkers (1997) found an incidence of 3.1 percent if membranes were
ruptured for longer than 24 hours.
Ananth and associates (2004) reported that the threefold risk of abruption with
preterm rupture was further increased with infection.
This same group has suggested that inflammation and infection as well as preterm
delivery may be the primary causes leading to abruption (Nath, 2007, 2008).
 Given other vascular diseases caused by smoking, it is not surprising that studies
from the Collaborative Perinatal Project linked this to an increased risk for
abruption (Misra, 1999; Naeye, 1980).
Results of metaanalyses of 1.6 million pregnancies included a twofold risk for
abruption in smokers (Ananth, 1999b).
This risk increased to five- to eightfold if smokers had chronic hypertension, severe
preeclampsia, or both.
 Women who use cocaine can have an alarming frequency of placental abruption.
Bingol and colleagues (1987) described 50 women who abused cocaine during
pregnancyeight had a stillbirth caused by placental abruption.
In a systematic review, Addis and associates (2001) reported that placental
abruption was more common in women who used cocaine than in those who did not.
 Women affected by some of these have higher associated rates of thromboembolic
disorders during pregnancy.
However, the link with placental abruption is less clear (American College of
Obstetricians and Gynecologists, 2012a, 2013a).
Lupus anticoagulant is associated with maternal floor infarction of the placenta, but
is less so with typical abruptions.
There is no convincing evidence that thrombophiliasfor example, factor V Leiden
or prothrombin gene mutationare associated with placental abruption.
 Especially if located near the mucosal surface behind the placental implantation
site, uterine myomas can predispose to abortion or later to placental abruption.
 Because many of the predisposing factors are chronic and therefore repetitive, it
would be reasonable to conclude that placental abruption would have a high
recurrence rate.
In fact, the woman who has suffered an abruptionespecially one that caused fetal
deathhas an extraordinarily high risk for recurrence.
In these women, Pritchard and associates (1970) identified a recurrence rate of 12
percentand half of these caused another fetal death.
Furuhashi and colleagues (2002) reported a 22-percent recurrence ratehalf
recurred at a gestational age 1 to 3 weeks earlier than the first abruption.
Looked at a second way, Tikkanen and coworkers (2006) found that of 114 parous
women who experienced an abruption, 9 percent had a prior abruption.
 A third perspective is provided by a population-based study of 767,000 pregnancies
completed by Rasmussen and Irgens (2009).
They reported a 6.5-fold increased risk for recurrence of a mild abruption and
11.5-fold risk for a severe abruption.
For women who had two severe abruptions, the risk for a third was increased 50-
fold.
Management of a pregnancy subsequent to an abruption is difficult because another
separation may suddenly occur, even remote from term.
In many of these recurrences, fetal wellbeing is almost always reassuring
beforehand.
Thus, antepartum fetal testing is usually not predictive (Toivonen, 2002).
 Most women with a placental abruption have sudden-onset abdominal pain, vaginal
bleeding, and uterine tenderness.
In a prospective study, Hurd and colleagues (1983) reported that 78 percent with
placental abruption had vaginal bleeding, 66 percent had uterine tenderness or back
pain, and 60 percent had a nonreassuring fetal status.
Other findings included frequent contractions and persistent hypertonus.
In a fifth of these women, preterm labor was diagnosed, and abruption was not
suspected until fetal distress or death ensued.
 Importantly, the signs and symptoms of placental abruption can vary considerably.
In some women, external bleeding can be profuse, yet placental separation may not
be so extensive as to compromise the fetus.
In others, there may be no external bleeding, but the placenta is sufficiently
sheared off that the fetus is deada concealed abruption.
In one unusual case, a multiparous woman cared for at Parkland Hospital presented
with a nosebleed.
She had no abdominal or uterine pain, tenderness, or vaginal bleeding.
Her fetus was dead, however, and her blood did not clot.
The plasma fibrinogen level was 25 mg/dL. Labor was induced, and a total abruption
was confirmed at delivery.