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PREGNANCY-RELATED CONDITIONS

PLACENTAL ABRUPTION

Placental abruption is exactly what it sounds like - abnormal detachment of the placenta from the uterine lining and wall (in a normal pregnancy, the placenta detaches from the uterine wall only after the baby has been delivered - this is called the afterbirth). Its prevalence is estimated to be fairly low at less than 1% of pregnancies. Placental abruption usually occurs in the third trimester, but can occur as early as in the second trimester in some cases. It can be partial (milder) or total (more severe). Symptoms include bleeding (but not necessarily because the blood can be trapped between the placenta and the uterine wall, which is called a concealed abruption), bloating (tenderness), abdominal and back pain, rapid contractions

Placental abruption can be caused by a variety of issues, such as trauma (accidents), drug abuse (cocaine), or preexisting chronic conditions (such as hypertensive disorders). Therefore, the only things you can do to reduce your risk of placental abruption is to have a safe and healthy lifestyle (avoid accidents and drug use, eat a healthy diet and stay active).  If you do have a placental abruption, treatment depends on whether the abruption is partial (milder) or total (stronger). Milder partial abruptions can be managed with cautious observation and monitoring either in the hospital or at home (including fetal heart rate monitoring, FHR, to make sure your baby has enough oxygen). If necessary, medical treatments that help the fetus mature (such as corticosteroids for lung maturation) can be given, so that your baby can be delivered preterm if need be. Stronger total abruptions can deprive the fetus of important nutrients and oxygen if left unattended, and can require immediate delivery either by induced labor or c-section. If your baby was delivered preterm due to placental abruption, it may need to stay in an incubator for a few days or even weeks. 

Risk Factors

  • Hypertensive disorders 

  • Drug use during pregnancy (cocaine)

  • Abdominal trauma during pregnancy (accidents)

  • Placental detachment during a previous pregnancy

  • Other chronic disorders such as diabetes or coagulative disorders 

  • Uterine abnormalities (such as uterine fibroids or endometriosis, though the latter has been controversial in the literature)

  • Multi-gestational pregnancy (twins or multiplets)

  • Uterine infection (choreoamniotitis)

  • Advanced maternal age (> 35)

  • Smoking

Symptoms

  • Rapid, longer and/or stronger contractions

  • Uterine bleeding (though not necessarily)

  • Abdominal pain and/or back pain

  • Decreased fetal movement

  • Bloating (tenderness) 

Risk Factors
Symptoms

Treatments

Partial (milder) abruptions:

  • Observation, either at the hospital or at home (if necessary with FHR monitoring and medical induction of fetal maturation)

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Total (more severe) abruptions:​​

  • Cesarean Section

  • Hysterectomy (rarely)

  • Maternal blood transfusions

  • Induction of labor (preterm vaginal delivery)

  • Medical induction of fetal maturation (corticosteroids)

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Complications

     Risks for the mother: ​

  • Organ failure (rarely)

  • Hemorrhage

  • Clotting

  • Shock

​

      Risks for the fetus:

  • Disability

  • Stillbirth (rare)

  • Preterm delivery

  • Oxigen deprivation

  • Nutrient deprivation

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Treatments
Complications
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