Placenta Abruptio - Topic Overview
What is placenta abruptio? Placenta abruptio is a problem with the placenta during pregnancy. The placenta is a round, flat organ that forms during pregnancy to give the baby food and oxygen from the mother. During a normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until the baby has been born. But with placenta abruptio, the placenta breaks away, or abrupts, from the wall of the uterus too early, before the baby is born. This problem can cause:
Premature birth. Low birth weight. Major blood loss in the mother.
Placenta abruptio can be very harmful for both the mother and the baby. In rare cases, it can cause death. See a picture of placenta abruptio .
Placenta abruptio is also called abruptio placenta or placental abruption. It affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th week of pregnancy. What causes placenta abruptio, and how can you lower your risk? Doctors aren't sure what causes placenta abruptio. But there are things that raise a womans risk for an abruption. These things are called risk factors. If you avoid them, you can lower your risk. Common risk factors for placenta abruptio include:
High blood pressure (140/90 or higher). This is the most common risk factor linked to placenta abruptio, whether the high blood pressure is chronic (long-term) or is caused by the pregnancy (preeclampsia). Having a placental abruption in the past. Smoking during pregnancy.
Less common risk factors for placenta abruptio include:
Using cocaine. Having a scar from a past surgery or a uterine fibroid where the placenta has attached to the wall of the uterus. Having an injury to the uterus. This could happen in a car accident. Premature rupture of membranes for 24 hours or more, especially when there is an infection in the uterus.
What are the common symptoms?
If you have placenta abruptio, you may notice one or more warning signs. Call your doctor right away if you are pregnant and have any of these symptoms:
Light or moderate vaginal bleeding. Bleeding caused by an abruption depends on where the abruption is and how long it has taken for the blood to pass. A uterus that hurts or is sore. It might also feel hard or rigid. Signs of early labor. These include regular contractions and aches or pains in your lower back or belly.
Call 911 or emergency services right away if you have:
Sudden or severe pain in your belly. Severe vaginal bleeding. Any symptoms of shock. These include feeling lightheaded or like you are going faint; feeling confused, restless or weak; feeling sick to your stomach or vomiting; and having fast, shallow breathing.
Placenta Abruptio - Topic Overview
(continued) You can't really tell how serious an abruption is by the amount of vaginal bleeding. There might be a serious problem even if there is only a little bleeding. Sometimes the blood can be trapped between the placenta and the wall of the uterus. In rare cases, symptoms of shock will be the only signs that there is a problem. How is placenta abruptio diagnosed? Your doctor will ask questions about your symptoms and will check your babys heart rate. You may have an ultrasound test. Your doctor might also do a blood test to see if you're anemic from losing blood. If your doctor thinks that you have a placental abruption, you'll likely have to stay in the hospital for at least a few hours. Your doctor will need to find out how severe the abruption is, if it is getting worse, and if it is affecting your baby. How is it treated? The kind of treatment you will have depends on:
How severe the abruption is. How it is affecting your baby. How close your due date is.
If you have a mild abruption, it may get better on its own. You may just be closely watched for the rest of your pregnancy. You may not have to stay in the hospital.
A medium to severe abruption means that you will likely have to stay in the hospital so that the baby's health can be watched closely. In most cases, the baby will need to be delivered, sometimes by emergency cesarean section.
Placental abruption
From Wikipedia, the free encyclopedia Jump to: navigation, search
Placental abruption
Classification and external resources
Ultrasound showing placental abruption. ICD-10 ICD-9 O45 641.2
DiseasesDB MedlinePlus eMedicine MeSH
40 000901 med/6 emerg/12 D000037
Placental abruption (also known as abruptio placentae) is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common pathological cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies worldwide. Placental abruption is a significant contributor to maternal mortality worldwide; early and skilled medical intervention is needed to ensure a good outcome, and this is not available in many parts of the world. Treatment depends on how serious the abruption is and how far along the woman is in her pregnancy.[1] Placental abruption has effects on both mother and fetus. The effects on the mother depend primarily on the severity of the abruption, while the effects on the fetus depend on both its severity and the gestational age at which it occurs.[2] The heart rate of the fetus can be associated with the severity.[3]
Contents
1 Lasting effects 2 Symptoms 3 Clinical Manifestation 4 Pathophysiology 5 Risk factors 6 Prevention 7 Intervention 8 Prognosis 9 References 10 External links
Lasting effects
On the mother:
A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery. 'APH weakens for PPH to kill'.
The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract. The mother may have problems with blood clotting for a few days. If the mother's blood does not clot (particularly during a caesarean section) and too many transfusions could put the mother into disseminated intravascular coagulation (DIC) due to increased thromboplastin, the doctor may consider a hysterectomy. A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication. In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported.
On the baby:
If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery and may die in utero, thus resulting in a stillbirth. The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding. If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth. The newborn may have low blood pressure or a low blood count. If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.
Symptoms
contractions that don't stop (and may follow one another so rapidly as to seem continuous) pain in the uterus tenderness in the abdomen vaginal bleeding (sometimes) uterus may be disproportionately enlarged pallor
Clinical Manifestation
Class 0: asymptomatic. Diagnosis is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta. Class 1: mild and represents approximately 48% of all cases. Characteristics include the following: o No vaginal bleeding to mild vaginal bleeding o Slightly tender uterus o Normal maternal BP and heart rate o No coagulopathy o No fetal distress Class 2: moderate and represents approximately 27% of all cases. Characteristics include the following: o No vaginal bleeding to moderate vaginal bleeding
Moderate-to-severe uterine tenderness with possible tetanic contractions Maternal tachycardia with orthostatic changes in BP and heart rate Fetal distress Hypofibrinogenemia (i.e., 50250 mg/dL) Class 3: severe and represents approximately 24% of all cases. Characteristics include the following: o No vaginal bleeding to heavy vaginal bleeding o Very painful tetanic uterus o Maternal shock o Hypofibrinogenemia (i.e., <150 mg/dL) o Coagulopathy o Fetal death
o o o o
Pathophysiology
Trauma, hypertension, or coagulopathy contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption. Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death. Abruptions are classified according to severity in the following manner:
Grade 0: Asymptomatic and only diagnosed through post partum examination of the placenta. Grade 1: The mother may have vaginal bleeding with mild uterine tenderness or tetany, but there is no distress of mother or fetus. Grade 2: The mother is symptomatic but not in shock. There is some evidence of fetal distress can be found with fetal heart rate monitoring. Grade 3: Severe bleeding (which may be occult) leads to maternal shock and fetal death. There may be maternal disseminated intravascular coagulation. Blood may force its way through the uterine wall into the serosa, a condition known as Couvelaire uterus.
Risk factors
Pre-eclampsia [2] Maternal smoking is associated with up to 90% increased risk.[4] o See also: Smoking and pregnancy Maternal trauma, such as motor vehicle accidents, assaults, falls or nosocomial infection. Short umbilical cord Prolonged rupture of membranes (>24 hours) Thrombophilia [2] Retroplacental fibromyoma Multiparity [2]
Multiple pregnancy[2] Maternal age: pregnant women who are younger than 20 or older than 35 are at greater risk. Previous abruption: Women who have had an abruption in previous pregnancies are at greater risk. Previous Caesarean section[2] some infections are also diagnosed as a cause cocaine intoxication[5]
Prevention
Although the risk of placental abruption cannot be eliminated, it can be reduced. Avoiding tobacco, alcohol and cocaine during pregnancy decreases the risk. Staying away from activities which have a high risk of physical trauma is also important. Women who have high blood pressure or who have had a previous placental abruption and want to conceive must be closely supervised by a doctor.[6] The risk of placental abruption can be reduced by maintaining a good diet including taking folic acid, regular sleep patterns and correction of pregnancy-induced hypertension. It is crucial for women to be made aware of the signs of placental abruption, such as vaginal bleeding, and that if they experience such symptoms they must get into contact with their health care provider/the hospital without any delay.
Intervention
Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with or without bleeding. The fundus may be monitored because a rising fundus can indicate bleeding. An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. The mother may be given Rhogam if she is Rh negative. Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks and neither mother or fetus is in any distress, then they may simply be monitored in hospital until a change in condition or fetal maturity whichever comes first. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother is in distress. Blood volume replacement to maintain blood pressure and blood plasma replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of disseminated intravascular coagulation. Patient should be monitored for 7 days for PPH. Excessive bleeding from uterus may necessitate hysterectomy if family size is completed.
Prognosis
The prognosis of this complication depends on whether treatment is received by the patient, on the quality of treatment, and on the severity of the abruption.
In the Western world, maternal deaths due to placental abruption are rare; for instance a study done in Finland found that, between 1972 and 2005 placental abruption had a maternal mortality rate of 0.4 per 1,000 cases (which means that 1 in 2,500 women who had placental abruption died); this was similar to other Western countries during that period.[7] The prognosis on the fetus is worse, currently, in the UK, about 15% of fetuses die following this event.[2] Without any form of medical intervention, as often happens in many parts of the world, placental abruption has a high maternal mortality rate.
