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placenta abruptio Images (Click to view larger image)
Alternative Names
abruptio placenta, placental abruption, ablatio placentae, accidental haemorrhage
Definition
Placenta abruptio during pregnancy is a condition in which the placenta, or afterbirth, separates from the uterus before the foetus is born. The placenta is a disc-shaped organ that provides nourishment and blood to a foetus. This condition occurs in about 1 out of 75 to 90 deliveries.
What is going on in the body?
In the normal birthing process, the placenta does not separate from the uterus until after the infant is born. In placenta abruptio, blood vessels rupture and create a mass of blood, also called a haematoma. This haematoma shears off the adjacent blood vessels, creating further bleeding and separation of the placenta.
There are two kinds of placenta abruptio, depending on whether the bleeding can be seen externally or not. The concealed form means that bleeding occurs within the uterine cavity and does not leave the cervix. In the external form of this condition, blood drains through the cervix and out the body.
What are the signs and symptoms of the condition?
Symptoms may vary, depending on how much of the placenta has separated and when in the pregnancy it occurs. Thirty percent of placental abruptions are small and produce no symptoms. When symptoms do occur they may include: - vaginal bleeding
- severe abdominal pain, which is different from uterine contractions
- uterine irritability, or more frequent, painful uterine contractions
- foetal distress, detected by foetal monitoring
- constant contractions, called uterine tetany
- back pain
- uterine tenderness
- shock, with low blood pressure and inadequate blood flow to vital organs
What are the causes and risks of the condition?
A woman is more likely to develop this condition if she: - has preeclampsia, a type of toxaemia or poison that develops during pregnancy
- has eclampsia, which is toxaemia during pregnancy that becomes severe
- has had this condition before
- has chronic high blood pressure
- is older
- has uterine distension from multiple pregnancies, or an excess of amniotic fluid
- has had more than four children
- has diabetes
- has other medical conditions, such as systemic lupus erythematosus
- smokes cigarettes
- has more than 14 alcoholic drinks per week
- uses cocaine
- has a history of an attempted internal version, a procedure in which the obstetrician tries changing the baby's position from breech to head first
- has an automobile accident during pregnancy
What can be done to prevent the condition?
Women can reduce their risk factors by: Good antenatal care will help to identify pregnancy risk factors and possibly allow for early recognition of placenta problems. This will enable treatment to be started right away.
How is the condition diagnosed?
A woman's doctor will look at her medical history and consider any symptoms. He or she also will look for any signs of foetal distress. Based on this information, the doctor may suspect placenta abruptio.
The diagnosis can be confirmed if: - a pregnancy ultrasound shows a clot behind the placenta
- a full blood count, or FBC, shows decreased haemoglobin, haematocrit, and platelets
- a bleeding tendency is found with clotting tests such as a prothrombin time, or PT
- the baby's heartrate or rhythm is abnormal
What are the long-term effects of the condition?
This condition can result in: - the death of the mother
- the death of the foetus
- excessive bleeding leading to shock
- a serious generalised bleeding problem called disseminated intravascular coagulopathy, or DIC
- kidney failure, also known as renal failure
- a liver disease called transfusion hepatitis
- low muscle tone, called uterine atony, with continued bleeding
- premature delivery, birth trauma, and risks associated with prematurity
What are the risks to others?
This condition can be harmful to the foetus. The woman also has a higher risk of developing this condition during future pregnancies.
What are the treatments for the condition?
This condition is usually an emergency and requires treatment right away. Measures will be taken to keep the mother and infant healthy. This might include: - immediate and continuous internal foetal monitoring of the infant
- IV fluids and blood transfusions
- monitoring of vital signs, such as blood pressure, heart rate, and urine output
- "watchful management" if the foetus is not in distress, the mother's vital signs are stable, and labour is not in motion. Some small abruptions will stop bleeding on their own.
- vaginal delivery if the infant and mother are stable
- caesarean section if the mother and infant are unstable
- blood transfusion if signs of shock are 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. It may take longer for a woman to recover from major abdominal surgery involved in a caesarean section. Risks for any surgery include bleeding, infection, and allergic reaction to the anaesthesia.
What happens after treatment for the condition?
After delivery, the woman will be watched closely for signs of continued bleeding. This entails monitoring frequent FBCs, evaluating clotting times, and watching vital signs. The surviving infant will likewise be observed in the intensive care unit.
How is the condition monitored?
If a woman is pregnant and develops any of the signs of this condition, she should call her doctor right away.
Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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