Placenta Abruption

Bleeding later in pregnancy causes: (second and third trimester)

Placenta abruption:

Possibility: 1/100.
After week 22 of pregnancy.
It is when the placenta prematurely separate either partially or completely from the inner wall of the uterus causes rupture of maternal blood vessels.

The cause is unknown, but it might be caused by an injury to the abdomen from a fall or car accident.

Other symptoms:
a. Back and abdominal pain
b. Contractions.
c. Uterine tenderness.
d. Firmness in abdomen.

The mother should go to the emergency immediately.

Risk factors:
a. history of placenta abruption in previous pregnancy.
b. Polyhydramnios.
c. Chronic hypertension.
d. High blood pressure during pregnancy.
e. Smoking, or exposed to tobacco.
f. preterm premature rupture of membranes.
g. Multiple pregnancy.
h. Older age.
i. Trauma.

Complications:
a. Fetal restricted growth.
b. Stillbirth.
c. premature birth.
e. Emergency C-section.
f. Complications of Heavy blood loss example: blood transfusion.
g. Need for hysterectomy.
e. Blood clotting problems with the mother.

Prevention:
It can not be prevented, but to reduce the risk, the mother should:
Be careful and avoid getting injured or falling
Quit smoking.
Control her blood pressure .

Management:
If both the mother and fetus are stable:
a. less than 34 weeks of gestation:
Wait until week 37 – 38 with close monitoring.
The mother might be given medications (antenatal corticosteroids) for fetal lung development.

b. at 34 to 36 weeks of gestation:
Delivery is recommended to avoid the risk of mother or fetus loss. Vaginal delivery is possible, but If the abruption progresses putting the fetus life at risk, urgent C-section is performed.

c. ≥36 weeks of gestation:
Delivery.

For mother with previous placenta abruption:
Ultrasound examination every 4 weeks from week 24 – 28 until delivery.
it is advised to deliver by week 40 or by a C-section at week 39 – 40.

In case of more than one prior placenta abruption, it is advised to deliver around week 37.