Hospitalization and observation are advised if all of the following are present: Bleeding does not threaten the life of the mother or fetus. This approach ensures that mother and fetus can be closely monitored and, if needed, rapidly treated. Women should be advised to refrain from sexual intercourse. Corticosteroids may also be given if all of the following are present: The pregnancy is late preterm 34 to 36 weeks.
The mother has not previously received corticosteroids during this pregnancy and has no contraindications. If bleeding resolves and maternal and fetal status remains stable, ambulation and usually hospital discharge are allowed. If bleeding continues or if status deteriorates, prompt cesarean delivery may be indicated. Complications of placental abruption eg, shock, DIC are managed with aggressive replacement of blood and blood products.
Treatment reference 1. N Engl J Med 14 —, It typically manifests as uterine bleeding and uterine pain or tenderness; bleeding varies in volume and acuity and, if the abruption is concealed, may be absent. Diagnose based on characteristic symptoms and signs. The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication. Placental Abruption Placental abruption is the separation of the placenta from the uterine wall before delivery.
Abruption is the most common cause of serious vaginal bleeding, occurring in 1 percent of pregnancies. Neonatal death occurs in 10 to 30 percent of cases. Preterm labor, growth restriction, and intrauterine fetal death also may occur.
Bleeding may be completely or partially concealed or may be bright, dark, or intermixed with amniotic fluid. Disseminated intravascular coagulation may result from the release of thromboplastin into the maternal circulation with placental separation. A Cochrane review found no randomized controlled trials assessing interventions for placental abruption that met inclusion criteria.
Delay can be fatal to the fetus; 30 percent of perinatal deaths in one case series occurred within two hours of admission. Acute blood clots and the placenta are hyperechoic on ultranography and difficult to distinguish from one another. Maternal stabilization requires serial evaluation of the hematocrit and coagulation studies to determine whether disseminated intravascular coagulation is present.
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Overt hypertension: it causes potential changes in the vasculature of the placenta and leads to placental dysfunction. Cigarette smoking: smoking and smoking by the partner are also an independent risk factor for abruption. It will increase the chance of abruption into multiple times. Cocaine usage during pregnancy: the high blood pressure and increased levels of catecholamines released by cocaine are considered to be responsible for the vasoconstriction in the uterine blood vessels that causes placental separation and abruption.
Abdominal trauma: injuries cause separation of the placental attachment from decidua. Clinical features In the majority of patients, placental abruption may present with abnormal vaginal bleeding during the second half of pregnancy. The amount of vaginal bleeding can vary greatly, and doesn't necessarily indicate how much of the placenta has separated from the uterus. The patient may also experience pain over the uterus which is a prominent feature in placental abruption.
Uterine contractions may occurs and cause additional, intermittent, pain. On palpation, uterus is extremely hard and tender, and it does not relax. Management and outcome depend on the gestational age, the degree of separation, and the maternal and fetal status.
Definition The premature separation of a normally located placenta from the uterine wall that occurs before delivery of the fetus. Placental abruption. Obstet Gynecol. A Revealed placental abruption, where blood tracks between the membranes, and escapes through the vagina and cervix. B Concealed placental abruption where blood collects behind the placenta, with no evidence of vaginal bleedingOyelese Y, Ananth CV. Used with permission [Citation ends]. History and exam.
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Placental Abruption Birth Injury and Complications
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