Call the Doctor, STAT! Abruption

We are continuing our discussion of emergency situations in Labor & Delivery. We all would prefer that our labor experience go as smoothly as possible, with as few interventions as possible, but sometimes things happen that necessitate the nurse crying out, "Call the Doctor, STAT!"


ABRUPTION

Placental abruption is the separation of the placenta from the inner wall of the uterus before

Image by {tribal} photography via Flickr

delivery. This is a serious, but uncommon, complication of pregnancy, occurring in only about 1% of all pregnant women. It usually occurs in the third trimester of pregnancy, but can occur as early as the 20th week of pregnancy. Most cases of abruption can be successfully treated, depending upon the amount of and type of separation that occurs, but abruption always requires immediate medical attention. Because placental separation can deprive the baby of oxygen and can cause heavy bleeding in the mother, untreated placental abruption puts both the mother and the baby in danger.


SIGNS AND SYMPTOMS

So how do you know if you might be expericing a placental abruption? The signs and symptoms would include one or more of the following:

• Vaginal bleeding (although in some cases, there is no bleeding)
• Abdominal pain
• Uterine tenderness
• Rapid uterine contractions, often with only a few seconds rest in between
• Back pain (may be felt in place of or with, abdominal pain)
• If being monitored in the hospital, changes in the fetal heart rate may be noticed

The amount of bleeding with placenta abruption can vary greatly, from none at all (in 20% of cases) to hemorrhaging. The amount of bleeding isn't necessarily proportionate to how much the placenta has separated from the uterus. For this reason any vaginal bleeding in the third trimest should be reported to your health care provider.

The pain associated with placental abruption can be just as varying as the bleeding. Some women can come in with incredible pain, some with a continual nagging backache and some with no pain at all. The abdominal and back pain often can begin suddenly.

FACTORS AND CAUSES

While no one can accurately predict when and to whom an abruption will occur, there are some factors which can increase the risk of placental abruption, including:

• Previous pregnancies -- the more times you have been pregnant, the more risk you have for placental abruption
• Multiple pregnancy --Being pregnant with twins, triplets or other multiples
  
• Previous placenta abruption --having had an abruption before may increase your risk by as much as 15 percent or more
• High blood pressure -- Both chronic hypertension and pregnancy-induced hypertension increase the risk of placental abruption
• Tobacco usage
  
• Cocaine and/or Methamphetamine use during pregnancy -- both of these substances can contribute to placental abruption
• Age -- Women of advanced maternal age --older than 35 -- have higher risk for an abruption
• Abdominal trauma -- such as a motor vehicle accident, a fall on the abdomen or a direct blow to the abdomen

DIAGNOSIS AND TREATMENT

Diagnosis of placental abruption will depend upon the severity of the symptoms. If there is hemorrhaging present or fetal heart rate changes inconsistent with expected fetal oxygenation, your health care provider will not spend much time on diagnostics. The primary focus will be a healthy baby and a healthy mother. If the extent of abruption is such that it jeopardizes your health or the baby's health, emergency delivery will be in order. The placenta can actually completely detach, causing severe changes in the fetal heart rate and hemorrhaging in the mother. In severe cases of abruption, fetal death is possible.

There is no way to stop the placenta from detaching once it has begun and no way to reattach it once it has begun to separate.

If the baby's fetal heart rate is stable and the bleeding is minimal, or stable, then there is probably time for more diagnostic testing. These tests may include an ultrasound, blood tests and continued fetal monitoring.

If it is determined that the abruption is minimal and the fetal heart pattern is normal, you may remain in the hospital for close monitoring. If your bleeding stops, and the baby's condition is stable, you may be allowed to go home with frequent follow-up visits at your health care provider.

CONCLUSION

The final diagnosis of placental abruption can only be made after delivery, when the placenta is examined. Don't hesitate to call your health care provider for any episode of third trimester bleeding, or for abdominal or back pain that is unlike the normal back discomfort you have been experiencing toward the end of labor.