Normally, the placenta, which is a round and flat structure that establishes a connection between you and your baby, remains firmly attached to the uterine wall until the baby is born. It provides the baby food and oxygen from the mother and allows transport of waste products from the baby to the mother for excretion.
There are a lot of placental problems that can occur during pregnancy. The most common placental problem is when a normally implanted placenta abruptly separates or breaks away from the uterine wall too early, before delivery of the fetus. The separation can be partial or complete.
The medical term for this condition is abruptio placenta or placenta abruptio. It usually occurs in the third trimester of pregnancy, and is the most common cause of late-trimester bleeding occurring in 1% of pregnancies at term. Since the placenta is the fetus’ lifeline, untimely detachment of the placenta can cause serious problems, as oxygen and nutrient delivery to the fetus becomes compromised. Maternal complication though, is rare.
There is no known precise explanation as to the mechanism of abruptio placenta. But there are a number of identifiable factors that will raise the woman’s risk for abruptio placenta. This includes the following: previous history of abruptio placenta, maternal hypertension, maternal trauma (injury to the uterus like in car accident), smoking during pregnancy, maternal cocaine abuse, premature rupture of membranes especially when there is co-existing uterine infection, and having a uterine scar from a past surgery where the placenta has unfortunately attached to.
Abruptio placenta most commonly presents with a triad of overt and external vaginal bleeding, sudden or severe pain in your belly, and shock. If the bleeding is severe, a woman may experience symptoms of shock such as fainting, lightheadedness, confusion, fast and shallow breathing. Less commonly though, abuptio placenta can present without actual bleeding. This happens if blood remains concealed or trapped between the placenta and the wall of the uterus. In this case, symptoms of shock will be the only sign that there is an ongoing problem inside.
If you have any of the above symptoms, call emergency services right away. This is a medical emergency that warrants prompt evaluation of severity of both maternal and fetal condition.
• With mild abruption, localized uterine pain, tenderness and moderate vaginal bleeding are noted, but there is no fetal monitoring abnormality.
• With moderate abruption, up to 25 to 50% of placental surface is separated with fetal monitoring showing distress.
• With severe abruptio, greater than 50% of placental separation occurs. Fetal monitoring shows the baby in critical condition or even dead in utero.
Management of abruptio placenta varies depending on the assessment of your obstetrician. If you and your baby are stable, remote from term, and your bleeding is minimal or decreasing and contractions are subsiding, a conservative in-hospital observation is all that you might need. Oftentimes, you may also need blood transfusion to replace blood loss. However, if you are more than 36 weeks pregnant and your bleeding is heavy but controlled, labor may be induced and you will deliver the baby vaginally. But if you and your baby are in jeopardy, an outright emergency c-section will be done as soon as the maternal vital signs are stabilized.
Unfortunately, abruption placenta can not be prevented. The best thing that every expectant mother can do is to keep related conditions and known risk factors under control. More importantly, any bleeding during late pregnancy should be reported immediately to your health care provider.
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