Placental abruption: Difference between revisions

Jump to navigation Jump to search
Line 76: Line 76:
== Intervention ==
== Intervention ==


Placental abruption is suspected when a pregnant woman has sudden localized uterine pain with or without bleeding. The [[fundus (uterus)|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 [[Blood type#Rhesus|Rh negative]].
Placental abruption is suspected when a pregnant woman has sudden localized uterine pain with or without bleeding. The [[fundus (uterus)|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 Rheogam if she is [[Blood type#Rhesus|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.
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.

Revision as of 22:48, 14 March 2009

Placental abruption
ICD-10 O45
ICD-9 641.2
DiseasesDB 40
MedlinePlus 000901
eMedicine med/6  emerg/12
MeSH D000037

WikiDoc Resources for Placental abruption

Articles

Most recent articles on Placental abruption

Most cited articles on Placental abruption

Review articles on Placental abruption

Articles on Placental abruption in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Placental abruption

Images of Placental abruption

Photos of Placental abruption

Podcasts & MP3s on Placental abruption

Videos on Placental abruption

Evidence Based Medicine

Cochrane Collaboration on Placental abruption

Bandolier on Placental abruption

TRIP on Placental abruption

Clinical Trials

Ongoing Trials on Placental abruption at Clinical Trials.gov

Trial results on Placental abruption

Clinical Trials on Placental abruption at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Placental abruption

NICE Guidance on Placental abruption

NHS PRODIGY Guidance

FDA on Placental abruption

CDC on Placental abruption

Books

Books on Placental abruption

News

Placental abruption in the news

Be alerted to news on Placental abruption

News trends on Placental abruption

Commentary

Blogs on Placental abruption

Definitions

Definitions of Placental abruption

Patient Resources / Community

Patient resources on Placental abruption

Discussion groups on Placental abruption

Patient Handouts on Placental abruption

Directions to Hospitals Treating Placental abruption

Risk calculators and risk factors for Placental abruption

Healthcare Provider Resources

Symptoms of Placental abruption

Causes & Risk Factors for Placental abruption

Diagnostic studies for Placental abruption

Treatment of Placental abruption

Continuing Medical Education (CME)

CME Programs on Placental abruption

International

Placental abruption en Espanol

Placental abruption en Francais

Business

Placental abruption in the Marketplace

Patents on Placental abruption

Experimental / Informatics

List of terms related to Placental abruption

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

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.[1]

Lasting effects

On the mother:

  • A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
  • The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract.
  • The mother may have problems with blood clotting for a few days.
  • If the mother's blood does not clot (particularly during a caesarean section) and too many transfusions could put the mother into disseminated intravascular coagulation (DIC), the doctor may consider a hysterectomy.
  • A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland.
  • In some cases where the abruption is high up in the uterus, or is slight, there is no bleeding, though extreme pain is felt and reported.

On the baby:

  • If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery.
  • The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding.
  • If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth.
  • The newborn may have low blood pressure or a low blood count.
  • If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.

Symptoms

  • contractions that don't stop
  • pain in the uterus
  • tenderness in the abdomen
  • vaginal bleeding (sometimes)

Pathophysiology

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.

Risk factors

  • Maternal hypertension is a factor in 44% of all abruptions.
  • Maternal trauma, such as motor vehicle accidents, assaults, falls, or nosocomial
  • Drug use is a factor, particularly tobacco, alcohol, and cocaine.
  • 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.

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.

Intervention

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 Rheogam 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.

References

  1. Usui R, Matsubara S, Ohkuchi A; et al. (2007). "Fetal heart rate pattern reflecting the severity of placental abruption". doi:10.1007/s00404-007-0471-9. PMID 17896112.
  • Bobak, Irene M; Lowdermilk, Deitra Leonard; Perry, Shannon E. (2000). Maternity & women's health care. St. Louis: Mosby. ISBN 0-323-00961-1.

External links

Template:WH Template:WS