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Placental abruption (Also known as abruptio placentae) is a complication of pregnancy, wherein the placental lining has separated from the uterus of the mother. It is the most common cause of late pregnancy bleeding. In humans, it refers to the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies world wide with a fetal mortality rate of 20-40% depending on the degree of separation. Placental abruption is also a significant contributor to maternal mortality.
The heart rate of the fetus can be associated with the severity.
Additional recommended knowledge
On the mother:
On the baby:
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:
The risk of placental abruption can be reduced by maintaining a good diet including taking folic acid, regular sleep patterns and not smoking or drinking alcohol.
Placental abruption is suspected when a pregnant woman has sudden localized uterine pain with or without bleeding. The fundus may be monitored because a rising fundus can indicate bleeding. An ultrasound may be used to rule out placenta previa but is not diagnostic for abruption. The mother may be given Rhogam if she is Rh negative.
Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than 36 weeks and neither mother or fetus are in any distress, then they may simply be monitored in hospital until a change in condition or fetal maturity whichever comes first.
Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement and to maintain blood pressure and blood plasma replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of disseminated intravascular coagulation.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Placental_abruption". A list of authors is available in Wikipedia.|