Placental Abruption

Placental Abruption is a condition where the placenta separates from the inner wall of the uterus causing complications to both. It is often a rare condition occurring in 1% of women which may happen anytime before the delivery especially in the third trimester.

What is Placental Abruption?

It is a rare complication occurring when the placenta separates from the inner wall of the uterus entirely or partially just before the delivery developing lack of oxygen and nutrients supply to the baby and massive bleeding in the mother.

How Common is it?

Placental abruption either partial or complete occurs in 1 out of 100-150 deliveries. However, the more severe type lies in about 1 out of 800-1600 deliveries.

Will it Affect the Baby?

It is an obstetrical emergency resulting in death and excessive blood loss in the mother.

Causes

The cause is unknown, but some possible causes include injury to the abdomen from an accident for example loss of amniotic fluid in the uterus.

Symptoms

  • Back pain
  • Vaginal bleeding
  • Abdominal pain
  • Tenderness in the uterine wall
  • Uterine contractions
  • Firmness in the abdomen or the uterus
  • Fetal heart rate abnormalities

Back pain and abdominal pain often begin suddenly, however, the amount of bleeding from the vagina depends on the placenta separated from the uterus. The bleeding might not be visible even with a severe case as the blood might trap inside the womb developing no signs. In some cases, it develops slowly causing light vaginal bleeding where one may have low amniotic fluid or other risks.

One who had it in the previous case are 10% more likely to have in their future pregnancy as per the March of Dimes.

Incidence

It complicates 1 in 100-120 cases with two-thirds severe instances based on maternal, fetal and neonatal morbidity. It is increasing in us, Canada and several Nordic countries due to the increased risk factors.

In a series of 500 abruptions with a live birth, 60.4% occurred in between 32-36 weeks and 14.3% before 32 weeks, however, the incidence rates depends on varying etiology.

Risk Factors

  • A history of placental abruption
  • Chronic high BP
  • High BP resulting in preeclampsia or eclampsia
  • A fall to the abdomen
  • Smoking
  • Being older
  • Infection in the uterus (chorioamnionitis)
  • Early rupture of the membranes causing leakage of the amniotic fluid
  • Multiple pregnancies
  • Use of cocaine
  • Uterine abnormalities

Diagnosis

The diagnosis is made by examining and monitoring the fetal condition through an ultrasound or blood tests to check the placenta. The incident may be suspected after the delivery too.

Your doctor may suspect placental abruption, but they can only truly diagnose it after you’ve given birth. They will try to collect as much information as possible to make the best decision for you and your baby.

Complications

For the Mother

  • Blood clots (disseminated intravascular coagulation)
  • Shock due to blood loss
  • A need for Blood transfusion
  • Failure of the kidneys or other organs
  • Hysterectomy due to uncontrollable uterine bleeding

For the Baby

  • Premature delivery
  • Stillbirth
  • Lack of oxygen supply
  • Congenital disabilities
  • Amnioreduction
  • Amniocentesis

Treatment

The treatment depends on the location, the effect due to the separation and the period. There can be a partial separation or a complete impacting the treatment type wherein in the case of partial separation bed rest is helpful while other situations require blood transfusions and emergy treatments as well.

Incomplete separation, delivery is the safest option where if the fetus is stable vaginal birth is possible however if one experiences heavy bleeding a cesarean may be needed. There is no treatment for placental abruption which can stop it from separating and any type of it can develop low birth weight, and premature birth was for severe kinds almost 15% end in fetal death.

  • Placental Abruption which is very light at 24-34 weeks: Is handled through medications
  • More than the 34th week: Need labor or case ran delivery to reduce future complications
  • Severe to mild: Cases need a C-section delivery

Note: Take folic acid after the recommendation by the doctor

Prevention

One cannot prevent if however can lower the risks, for example, avoid smoking or using drugs, on having a high BP consult the health care provider immediately, always wear a seatbelt, etc.

If one has a placental abruption and planning for the second pregnancy, consult the doctor immediately to avoid any unknown risks.

Outlook

One with such a condition posses the high risk of complications like:

  • Growth restriction at an average rate
  • Stillbirth
  • Premature birth occurring before the 37th week

It’s vital to seek immediate treatment in case of placental rupture to avoid more severe complications in the future. 15% of the incidents face the death of the fetus according to the American pregnancy association.

When to Call a Doctor

One should immediately call a doctor if experiencing heavy bleeding in the third trimester requiring a proper diagnosis for the later-term bleeding.

ICD-9 and ICD-10 Codes

ICD-9 code is 641.21

ICD-10 code is O43.893

References

https://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458

http://americanpregnancy.org/pregnancy-complications/placental-abruption/

https://www.healthline.com/health/pregnancy/complications-placental-abruption#outlook

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