Abruptio Placentae Placenta Abruptio

Overview, Causes, & Risk Factors

Placenta abruptio during pregnancyis a condition in which the placenta, also known as the afterbirth,separates from the womb before the fetus is born. The placenta is adisc-shaped organ that provides nourishment and blood to a fetus.This most common form of this condition occurs in about 1 out of 150 deliveries.The severe form occurs in only 1 out of 500 to 750 births.

What is going on in the body?

In the normal birthing process, the placenta does notdetach from the womb until after the infant is born. In placentaabruptio, blood vessels rupture and create a mass of blood, alsocalled a hematoma. This hematoma shears off the bloodvessels next to it, creating further bleeding and separation of the placenta.

There are two kinds of placenta abruptio, relating towhere the bleeding occurs:

  • Concealed. This form means that bleeding occurswithin the uterus and does not leave the cervix.
  • External. In this form, blood drainsthrough the cervix and out of the body.
  • What are the causes and risks of the condition?

    It may not be easy to tell what caused placenta abruptio. In fact,doctors can detect an exact cause in less than 5 out of 100 cases. Some causes(though rare) can include:

  • abdominal trauma from an automobile accident or a fall
  • sudden loss in size of the uterus, due to loss of amniotic fluid, or deliveryof a first twin
  • abnormally short umbilical cord
  • However, a woman is more at risk for this condition if she:

  • has had this condition before
  • has preeclampsia,which is a condition that develops during pregnancy as a result ofhypertension
  • has eclampsia,which is toxemia during pregnancy that becomes severe
  • has chronic high blood pressure
  • is older
  • has uterine distension from multiple pregnancies, or an excess ofamniotic fluid
  • has had more than four children
  • has diabetes
  • has other medical conditions, such assystemic lupus erythematosus
  • smokes cigarettes
  • has more than 14 alcoholicdrinks per week
  • uses cocaine
  • has a history of an attempted internal version, a procedure in whichthe obstetrician tries changing the baby’s position from breech to head first
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Symptoms may vary, depending on:

  • how much of the placenta has detached
  • during which stage of pregnancyit occurs
  • Thirty percent of placenta abruptios are small and produce nosymptoms. When the case is severe, symptoms may include:

  • vaginal bleeding
  • severe abdominal pain, which is different from uterine contractions
  • uterus is tender and contracted tightly
  • fetal distress, detected by fetal monitoring
  • constant contractions, called uterine tetany
  • back pain
  • uterine tenderness
  • maternal shock,with low blood pressure and inadequate blood flow to vital organs
  • This condition is sometimes confused withplacenta previa.

    Diagnosis & Tests

    How is the condition diagnosed?

    A woman’s doctor will look at her medicalhistory and consider any symptoms. He or she also will look for any signsof fetal distress and for tenderness or increased tightness over the uterus.Based on this information, the provider may suspectplacenta abruptio.

    The diagnosis can be confirmed if:

  • a pregnancy ultrasoundshows a clot behind the placenta
  • a complete blood count, called CBC,shows decreased hemoglobin,hematocrit, and platelets
  • a bleeding tendency is found with clotting tests such as a prothrombintime, or PT
  • the baby’s heart rate or rhythm is abnormal
  • Prevention & Expectations

    What can be done to prevent the condition?

    Women can reduce their risk factors by:

  • avoiding general pregnancy risk factors,such as cocaine, alcohol,or smoking
  • treating chronic high blood pressureor other conditions, such as diabetes
  • Good prenatal care will help to identifypregnancy risk factorsand possibly allow for early detection of placenta problems. This willmean that treatment can be started right away.

    What are the long-term effects of the condition?

    This condition can result in:

  • the death of the mother
  • the death of the fetus
  • excessive bleeding leading toshock
  • a serious generalized bleeding problem called disseminatedintravascular coagulopathy, or DIC
  • kidney failure, also known asrenal failure
  • a liver disease called transfusionhepatitis
  • low muscle tone, called uterine atony, with continued bleeding
  • premature delivery, birth trauma, and risks associated withprematurity
  • However, these results are rare. Maternal death occurs in less than5 out of 100 women who have placenta abruptio. Fetal death rates are higher.The infant may die in as many as 20 to 35 percent of cases.

    What are the risks to others?

    This condition can be harmful to the fetus. The woman alsohas a higher risk of developing this condition during future pregnancies.

    Treatment & Monitoring

    What are the treatments for the condition?

    This condition is usually an emergency and requirestreatment right away. Measures will be taken to keep the motherand infant healthy. This might include:

  • immediate and continuous internal fetal monitoring of the infant
  • IV fluids
  • monitoring of vital signs, such as blood pressure, heart rate, and urine output
  • “watchful management” if the fetus is not in distress, the mother’svital signs are stable, and labor is not in motion. Some small abruptioswill stop bleeding on their own.
  • vaginal delivery if the infant and mother are stable
  • cesarean sectionif the mother and infant are unstable
  • blood transfusionif signs of shockare present
  • What are the side effects of the treatments?

    Because the treatments for this condition may be life-saving,the potential side effects should be weighed against the loss of life. Itmay take longer for a woman to recover from major abdominal surgeryinvolved in a cesarean section.Risks for any surgery include bleeding, infection, andallergic reactionto the anesthesia.

    What happens after treatment for the condition?

    After delivery, the woman will be watched closely for signsof continued bleeding. This entails monitoring frequentCBCs,evaluating clotting times, and watching vital signs. The surviving infantwill likewise be observed in the intensive care unit.

    How is the condition monitored?

    If a woman is pregnantand develops any of the signs of this condition, she should call herdoctor right away.

    Article type: xmedgeneral

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