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Placenta Abruption

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Kunle Emmanuel
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Placenta Abruption

Unread post by Kunle Emmanuel » Tue Mar 06, 2018 4:16 pm

Topic: Placenta Abruption

Brief

The placenta is an organ that develops in your uterus during pregnancy. This structure provides oxygen and nutrients to your growing baby and removes waste products from your baby's blood. The placenta attaches to the wall of your uterus, and your baby's umbilical cord arises from it.
Placental abruption is an abnormal separation of the placenta to its attachment in the womb. This is an emergency, and is most likely to occur in the last trimester of pregnancy, most especially in the last few weeks before birth.

Classical Signs and Symptoms

1. Vaginal bleeding (may not be present at all times): The vaginal bleeding noticed by women with ongoing placental abruption varies, in most cases the bleeding is hidden (trapped) behind the placenta and it may not be visible
2. Sudden Abdominal pain
3. Uterine tenderness
4. Sudden Back pain
5. Rapid uterine contractions, often coming one right after another
6. In clinical practice, placental abruption develops slowly.
In such situations patients could notice light, intermittent vaginal bleeding.

When to see a doctor if you suspect placental abruption
Placental abruption is an emergency. If you experience any classic signs or symptoms of placental abruption which includes: Vaginal bleeding, Abdominal pain, Severe back pain and Rapid uterine contractions; please see a gynecologist ASAP.

Causes

1. No one knows the specific cause of placental abruption, UNKNOWN.
However, there are telltale signs in a woman’s past and present antenatal or obstetrics history could point to a likelihood or increased chances of developing placental abruption.

Possible/likely causes include:

1. Abdominal trauma or direct injury to the abdomen — from an auto accident or fall.
2. Also any situation which causes a rapid gush of amniotic fluid from the womb could lead to sudden negative pressure and could potentially cause abruption; for example, during spontaneous rupture of membranes or lack of controlled rupture of membranes (during induction of labor : IOL).
Points To Note
*NB: rupture of membranes for IOL is safe when done appropriately. I am not saying you should not have IOL if indicated, I am only saying that the doctor would pay attention when this is done to reduce the risk of abruption.

3. Past and present antenatal or obstetrics history which could indicate possibility of increase risk of placental abruption, includes;
• Previous placental abruption. If you've experienced placental abruption before, you're at higher risk of it happening again. With 1 previous abruption this increases the risk to 4.4% risk of it happening again in the next pregnancy and if you had 2 previous pregnancies complicated by abruption: 19-25% risk of it happening again.
• High blood pressure. High blood pressure — whether chronic or as a result of pregnancy — increases the risk of placental abruption.
• Abdominal trauma. Trauma to your abdomen — such as from a fall or other type of blow to the abdomen — makes placental abruption more likely.
• Substance abuse. Placental abruption is more common in women who smoke or use cocaine during pregnancy.
• Premature rupture of the membranes. During pregnancy, the baby is surrounded and cushioned by a fluid-filled membrane called the amniotic sac. The risk of placental abruption increases if the sac leaks or breaks before labor begins.
• Blood-clotting disorders. Any condition that impairs your blood's ability to clot increases the risk of placental abruption.
• Multiple pregnancy. If you're carrying more than one baby, the delivery of the first baby can cause changes in the uterus that trigger placental abruption before the other baby or babies are delivered.
• Maternal age. Placental abruption is more common in older women, especially after age 40.

Complications

Placental abruption can cause life-threatening problems for both mother and baby.
For the mother, placental abruption can lead to:
1. Shock due to blood loss
2. Blood clotting problems (disseminated intravascular coagulation)
3. The need for a blood transfusion
4. Failure of the kidneys or other organs

For the baby, placental abruption can lead to:
1. Deprivation of oxygen and nutrients
2. Premature birth
3. Stillbirth/death of the unborn child.
4. After the baby is born, bleeding from the site of the placental attachment is likely.
5. In the rare instance that the bleeding can't be controlled, emergency removal of the uterus (hysterectomy) might be considered and needed.

Tests and diagnosis
• On suspicion of placental abruption, you doctor would do a physical exam to check for uterine tenderness or rigidity,
• do a vaginal examination to assess the volume to blood loss and or any other sites of vaginal bleeding.
• Requests for blood tests; like clotting profile,
• Do an ultrasound, to monitor the unborn baby.

Treatments and drugs

• When placental separation occurs clearly it not possible to reattach it.
• Treatment options for placental abruption depend on the circumstances:

1. The baby isn't close to full term.
If the abruption seems mild, your baby's heart rate is normal and it's too soon for the baby to be born — generally before 34 weeks of pregnancy — you might be hospitalized for close monitoring. If the bleeding stops and your baby's condition is stable, you might be able to rest at home. In some cases, you might be given medication to help your baby's lungs mature, in case early delivery becomes necessary.
2. The baby is close to full term.
If your baby is almost full term — generally after 34 weeks of pregnancy — and the placental abruption seems minimal, a closely monitored vaginal delivery might be possible. If the abruption progresses or jeopardizes your health or your baby's health, you'll need an immediate delivery — usually by C-section. If you experience severe bleeding, you might need a blood transfusion.
Prevention
• Placental abruption cannot be prevented directly, however the risks could be significantly reduced.
• As we have discussed above there are certain risk factors that make placental abruption more likely.
• For example, clearly you would be advised not to smoke or use illegal drugs, such as cocaine.
• Ensure you are appropriately treated when you have high blood pressure.
• Following direct trauma to the abdomen following an auto accident, fall or other injury for example, should prompt urgent review due to the increased risk of placental abruption and other complications.
• If you've had a placental abruption and are planning another pregnancy, talk to your health care provider to see if there are any ways you might be able to reduce the risk of another abruption before conceiving again.
• Also expect (and if necessary request for) your health care provider to carefully monitor your condition throughout the pregnancy.

Thank you.

Copied from ATG Group

Reference

Mayo Clinic.


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