Placental Abruption Awareness

[Eve]

Placental abruption (abruptio placenta) is an uncommon — but serious — complication of pregnancy that requires immediate medical attention.

The placenta is a structure that develops in the uterus during pregnancy to nourish the growing baby. If the placenta peels away from the inner wall of the uterus before delivery — either partially or completely — it's known as placental abruption. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. Left untreated, placental abruption puts both mother and baby in jeopardy.

Placental abruption can begin anytime after 20 weeks of pregnancy. Classic signs and symptoms of placental abruption include:

* Vaginal bleeding
* Abdominal pain
* Back pain
* Uterine tenderness
* Rapid uterine contractions, often coming one right after another

Abdominal and back pain often begin suddenly. The amount of vaginal bleeding can vary greatly. The amount of blood doesn't necessarily correspond to how much of the placenta has separated from the inner wall of the uterus.

If you experience any signs or symptoms of placental abruption, seek emergency care.

The specific cause of placental abruption is often unknown.

In a few cases, trauma or injury to the abdomen — from an auto accident or fall, for example — causes placental abruption. Rarely, placental abruption is caused by an unusually short umbilical cord or rapid loss of the fluid that surrounds and protects the baby in the uterus (amniotic fluid).

Various factors may increase the risk of placental abruption, including:

* Previous pregnancies. The more times you've been pregnant, the higher your risk of placental abruption.
* Previous placental abruption. If you've experienced placental abruption before, the risk of experiencing it again may be 15 percent or even higher. The risk of preterm birth and preeclampsia — a serious pregnancy complication that causes high blood pressure and protein in the urine — also is higher.
* High blood pressure. High blood pressure increases the risk of placental abruption, whether you have chronic high blood pressure or the high blood pressure first developed during pregnancy.
* Blood-clotting disorders. Any condition that impairs your blood's ability to clot increases the risk of placental abruption.
* Multiple pregnancy. Carrying twins, triplets or other multiples increases the risk of placental abruption.
* Excess amniotic fluid. The risk of placental abruption is higher if you have an unusually large amount of amniotic fluid.
* Age. Placental abruption is more common in women age 40 and older.
* Abdominal trauma. Trauma to the abdomen — such as from a fall or other type of blow to the abdomen — increases the risk of placental abruption.
* Substance abuse. Placental abruption is more common in women who smoke, drink alcohol, or use cocaine or methamphetamine during pregnancy.

Seek emergency care if you experience any signs or symptoms of placental abruption, including:

* Vaginal bleeding
* Abdominal pain
* Back pain
* Rapid uterine contractions

If your health care provider suspects placental abruption, he or she will check for uterine tenderness or rigidity. You may need blood tests or an ultrasound to help identify possible sources of vaginal bleeding. During the ultrasound, high-frequency sound waves are used to create an image of your uterus on a monitor. Often, however, placental abruption can't be confirmed until after delivery — when the placenta is delivered with an attached blood clot.

Placental abruption can cause life-threatening problems for both mother and baby. Without prompt treatment, maternal blood loss may lead to shock. Your baby may be born prematurely and deprived of oxygen and nutrients. Sometimes, decreased oxygen to the brain leads to later neurological or behavioral problems. In severe cases, stillbirth is possible.

Blood loss may be a concern after delivery, too. If bleeding from the site of the placental attachment can't be controlled after the baby is born, emergency removal of the uterus (hysterectomy) may be needed.

Treatment for placental abruption depends on the circumstances.

If the abruption seems mild, your baby's heart rate is normal and it's too soon for the baby to be born, you may be hospitalized for close monitoring. If the bleeding stops and your baby's condition is stable, your health care provider may prescribe rest at home. In some cases, you may be given medication to help your baby's lungs mature — in case early delivery becomes necessary.

If you're 36 weeks or more into your pregnancy and placental abruption is minimal, a closely monitored vaginal delivery may 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 may need a blood transfusion.

There's no way to reattach a placenta that's separated from the wall of the uterus.

You can't prevent placental abruption, but you can decrease certain risk factors. Don't smoke, drink alcohol or use illicit drugs during pregnancy. If you have high blood pressure or diabetes, work with your health care provider to control your condition.

If you've had a placental abruption, talk to your health care provider before conceiving again. When you become pregnant, your health care provider will carefully monitor your condition.




I suffered from a complete placental abruption when I was 37 weeks pregnant with my second child. First child, no major complications and vaginal delivery at 40 weeks. I have been to the perinatologist for my area and she explained where I had suffered from a previous abruption before my risk now increases to 20-30% of it happening again. I am being monitored more this time etc.

I wanted people to be aware of this condition and learn some of the warning signs to help prevent what happened to me (Loss of our son 8 hours after delivery via emergency c-section)

I had high blood pressure for almost 2 months before the abruption occurred.
I had stomach pain when leaning forward (even a few inches) the last few weeks to the point of cleaning after a washroom visit was agony. I suffered from SPD which I do not believe had any part in the abruption. I had a general ill feeling most of the pregnancy and had a fear of loosing him from the start, even though I had no other bad experiences before this pregnancy. I went to my routine appt around 36 weeks and Kaleb was only measuring 32 weeks (which was the last time I was in to the doctor was 32 and he was normal in his measurements) He was 4 weeks behind and the doctor said it could be his position and if I still measured small the following week then she would do an ultrasound. I was on my way to see her the following week when my placental detached and I hemorrhaged and was rushed by ambulance to the nearest hospital 40 minutes (ish) away where I had an emergency c-section and Kaleb was delivered at 4:23pm. He and I both needed transfusions and Kaleb suffered from severe brain damage due to blood loss and lack of oxygen. He passed away 8 hours after delivery.

I do not want to scare anyone here, but just wanted to make this condition known, so maybe, just maybe someone can prevent this from happening to them

 

[Eve]

Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes the blood will pool behind the placenta, known as concealed or internal placental abruption.

Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature contractions, fetal distress or death.

Abruptions are classified according to severity in the following manner:

* Grade 0: Asymptomatic and only diagnosed through post partum examination of the placenta.
* Grade 1: The mother may have vaginal bleeding with mild uterine tenderness or tetany, but there is no distress of mother or fetus.
* Grade 2: The mother is symptomatic but not in shock. There is some evidence of fetal distress can be found with fetal heart rate monitoring.
* Grade 3: Severe bleeding (which may be occult) leads to maternal shock and fetal death. There may be maternal disseminated intravascular coagulation. Blood may force its way through the uterine wall into the serosa, a condition known as Couvelaire uterus.

[edit] Risk factors

* Maternal hypertension is a factor in 44% of all abruptions.
* Maternal trauma, such as motor vehicle accidents, assaults, falls, or nosocomial
* Short umbilical cord
* Prolonged rupture of membranes (>24 hours)
* Retroplacental fibromyoma
* Maternal age: pregnant women who are younger than 20 or older than 35 are at greater risk.
* Previous abruption: Women who have had an abruption in previous pregnancies are at greater risk.
* some infections are also diagnosed as a cause

The risk of placental abruption can be reduced by maintaining a good diet including taking folic acid, regular sleep patterns and correction of pregnancy-induced hypertension.

 

[BBonBoard]

wow, thanks for sharing.

 

[Eve]

I figured women should know about this, as I hadn't heard of it until a few weeks before it happened to me when my blood pressure wouldn't go down.

 

[Bunnipowder]

Good info

 

[purpledahlia]

thanks, i didnt know anything about this till now!

 

[Eve]

That is why I wanted to start this thread and a friend of mine mentioned it would be a good idea to inform you all on this condition It isn't well known at all!

 

[lottie_2007]

My friend lost her baby to this, she didn't know about it until she went into labour and her baby had died in the womb. I hadn't heard of it until then xx

 

[FemmeEnceinte]

Good bit of info! Another risk I'm not sure was included is placenta previa. If you have this, you're at a greater risk of an abruption and should abstain from anything other than only the necessary day to day activities.

 

[v2007]

My friend also lost her wee boy to PA, she was 34 weeks, she was in slow labour and her waters went, turned out it wasnt her waters but PA.
He dies in utero and was born sleeping the next day.

V xxxxx

 

[sun]

Thanks for posting this important info. It is important to know the signs and symptoms to look out for so we can be aware.
I'm so sorry to hear about your son

 

[Eve]

I thought it was my water that broke and was all excited until my OH who was driving looked down and said it was blood... then gush after gush came until I lost consciousness on the way to the hospital in the ambulance. I had pains for a few hours prior and thought maybe it was the start of labor but there was no way to tell as my uterus was already contracting so rapidly by the time I was seen by any medical professionals.

Femme- I had a few friends ( one pregnant right now) with placenta previa. One good thing about that is most cases can be detected early and are known and monitored from there on out by ultrasounds. My placental was actually low lying this pregnancy. It was detected at 9 weeks but at my 18 week ultrasound it had migrated more towards my back due to my uterus growing etc... One friend was diagnosed with placenta previa but delivered vaginally as it also slowly migrated out of the way Friend who is pregnant right now had her lying low at her 20 week scan so she now has to have another scan in 8 weeks to check the location. The main problem before delivery is bleeding, and in most cases now the doctors will do a c-section a little early as vaginal delivery isn't usually the safest method when dealing with placenta previa.

Between 3-6 of every 1000 women will have this problem. As the lower part of the uterus stretches in the second half of pregnancy, the placenta may become detached, causing severe bleeding. The baby cannot be born vaginally if the placenta is totally obstructing the opening from the womb.
Placenta previa can be divided into four types, of which the first two are the most common:

I the placenta is positioned low in the womb, but the baby can still be born vaginally.

II the lower edge of the placenta touches the opening of your cervix, but does not cover it, so the baby can be born vaginally.

III the placenta partially covers the opening of your cervix. The baby will need to be born by cesarean section.

IV the placenta completely covers the opening of your cervix. The baby will need to be born by cesarean section.

If you have an ultrasound scan in early pregnancy and the placenta seems to be near, or even covering the cervix, don't be too alarmed. It almost certainly is not placenta previa. As your baby grows, your expanding uterus naturally pulls the placenta away from your cervix. Even if the placenta is still low-lying at your 20-week scan, it may well not present a problem once you are full-term.

Women who are having their second or subsequent baby are more at risk than women having their first. Also slightly more at risk are women who have given birth to a baby by cesarean section, or who have previously had a pregnancy with placenta previa, or who smoke. However, most women with placenta previa have no obvious risk factors.

How is placenta previa managed?


This depends on whether you're bleeding and how far on in your pregnancy you are. If the condition is diagnosed after the 20th week, but you're not bleeding, you'll probably be advised to refrain from any vigorous exercise and to take life easy. If you're bleeding heavily, you will be admitted to hospital so that the bleeding can be monitored, but even when it stops, you might well be asked to stay in hospital until your baby is ready to be born.

Lesley had her first episode of bleeding at 32 weeks -- the loss was similar to a period. She was told to rest quietly at home, but four days later, she had another heavier bleed and was admitted to hospital for five days before being allowed home again.

"The only reason they let me out of hospital is that my husband works at home," says Lesley. "Otherwise I would probably have had to stay in for the rest of my pregnancy." Lesley was given steroid injections to help her baby's lungs mature in case he was born early.

She went into hospital for a planned cesarean section at 36 weeks. Her son was healthy at birth. Lesley lost some blood during the operation and needed a small transfusion afterward. She made a full recovery.

 

[Eve]

Thank you Sun

 

[Eve]

After I had the abruption I was not able to be on any forms of birth control as the doctor had to rule out any clotting disorders and I had to have a thrombophillia workup done, as well as many other testing. There was no known cause for what happened to me and Kaleb other than the high blood pressure. I got the okay to start taking birth control but figured I wouldn't bother messing with my body anymore. It took around 6 months to get the full go ahead and from there I had to wait 18 months between c-sections, so at least 9 months after Kaleb's delivery to try for another child. I felt 9 months was too soon for us, so it didn't happen until 14 months after my previous delivery. Everything seems well with us so far, and with how many times I am going to see the specialists and OB's I am pretty sure our little girl is going to stay with us

 

[sun]

I also have an anterior / low-lying placenta that was partially covering the cervix at my last scan (7 weeks ago). As you mentioned, most cases of low-lying placenta migrate out of the way by the end of pregnancy. I need to get an additional scan at 32 weeks to make sure it has moved, otherwise I will need a C-section.

Thanks again for the info!
xx

Just read your last post - good to hear they are being so thorough with their testing. And good to hear they didn't find anything chronic conditions which could have caused the PA. Hope the next few months are stress-free until you meet your little girl!!

 

[FemmeEnceinte]

Oh yes, if it's found early and not complete placenta previa it can indeed move upwards as your womb grows up and stretches it should bring the placenta with it. In the vast majority of previas, it moves in time. Often full previas are detected as a result of bleeding (subchorionic hematoma) and usually fairly early on.

Good work, plonk it all in your first post maybe and try and get it stickied?

 

[Eve]

Sun- I hope your scan at 32 weeks shows the placenta moved out of the way enough to enable you to have a vaginal delivery C-sections are not a terrible thing, but the recovery time from a vaginal delivery is much faster and less painful

Thank you and I hope so as well, I have some stress but that is due to some Post-traumatic stress syndrome I have suffered from. The further I get, the more I feel my anxiety acting up. I am sure once I get in and see the specialist again and get another peek at our little girl all these emotions with subside for a while Again thanks!

 

[Eve]

Femme- I am not sure I understand what you mean about stickied? Do you mean have it stay at the top of the list of threads? If so I would like to do a little more research and possibly go through my medical records and read a few medical journals before having something stuck lol Even get some more information from the high risk specialist I see on the 24th and the OB I see on the 16th.

 

[FemmeEnceinte]

I've read a fair few medical journals in my time and your info to now is about right. So long as people know what to look for and what to expect if it happens to them, you've done your bit to promote awareness.

 

[FemmeEnceinte]

Unless, of course, you intention is to do more than just this thread?