Placental Abruption

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Placental abruption is the separation of the placenta from the uterine lining after the twentieth week of pregnancy. This condition will occur in roughly 1% of women. If the abruption is small, the condition can be managed by physical and pelvic bed rest accompanied by close monitoring by the provider. If the vaginal bleeding stops, and the infant is viable, there is a good chance that the abruption will resolve spontaneously as long as the bed rest is followed. Depending on the clinical presentation, your provider may decide to treat the pregnancy with a steroid, betamethasone, to accelerate the fetal lung maturity if the provider thinks that there is a chance for an early delivery.

Vaginal bleeding is the most common presentation of placental abruption. Other symptoms can include uterine tenderness or pain, preterm labor, and fetal compromise manifested by decreased heart rate or decelerations (dipping of the fetal heart rate with contractions which are demonstrated on a fetal monitor or auscultated with a doppler). A placental abruption can be life threatening for the patient and the fetus, and the patient must be evaluated quickly as the placenta is what provides oxygen to the fetus.

There can be a partial or complete placental abruption. As the name implies, a partial separation is where a part of the placenta separates from the uterine lining and a part of the placenta is still attached. A complete separation involves the complete separation of the placenta from the uterine lining. As mentioned previously, a placental abruption can produce vaginal bleeding, but not always. Sometimes, the abruption can be occult, or hidden, as part of the placenta will separate, but there will still be enough attached placenta to hide the bleeding.

Monitoring of the patient and fetus is crucial. If the patient and fetus are stable, the provider will perform an ultrasound, blood work which will include type and crossing for possible transfusion(s) along with a hematocrit and hemoglobin, a pelvic exam with a speculum to assess the amount of vaginal bleeding and to make sure that the bleeding is not coming from elsewhere, and fetal monitoring. Intravenous (IV) access is a must in this situation.

If there are uterine contractions, the provider may elect to use magnesium sulfate to relax the uterus. The use of magnesium sulfate will depend on the stability of the patient and the viability of the fetus.

If you are Rh negative, and your partner is Rh positive, you will receive RhoGam which will protect you against isoimmunization. Isoimmunization is a condition where the mother forms antibodies that cross the placenta and rupture the fetal blood cells leading to fetal anemia which might require early delivery. The more times the patient gets pregnant, the worse the condition will get. This condition can lead to fetal death known as erythroblastosis fetalis. The bottom line is you will get RhoGam.

Some placental abruptions occur without a specific reason. There are factors, however, which increase the likelihood of an abruption. These factors include smoking, using drugs such as cocaine or methamphetamines, trauma to the abdomen, more than one fetus, uterine abnormalities like a septated uterus, history of a previous abruption and maternal age greater than 35 years.

Depending on the severity of the abruption, the provider may attempt to manage the pregnancy conservatively, deliver the pregnancy vaginally or deliver the pregnancy by cesarean section.

Remember that the incidence of placental abruption is low. If you experience any of the above symptoms, especially vaginal bleeding, contact your provider immediately. Wishing you a safe and enjoyable delivery.

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