Saturday, January 14, 2012

Abruptio Placentae : Bleeding in Pregnancy

Dr Deepika Tiwari, Gynecologist, Gurgaon
Abruptio placentae, also called premature separation of the  placenta, is a serious complication of pregnancy. The placenta separates away from the inner wall of the uterus before delivery. Untreated abruption can harm both mother and baby. It can mean compromised oxygen and nutrients for the baby and heavy bleeding in the mother.  It’s a medical emergency.

Risk factors include hypertension, trauma, and multiple pregnancies. Abnormalities of pregnancy called chorioamnionitis and polyhydramnios are also risk factors. Others are age (younger than 20 and older than
35), preeclampsia, diabetes, smoking, use of cocaine, and alcohol consumption.

The main symptoms are uterine bleeding, abnormal uterine contractions, and fetal distress . Contractions are painful and obvious. Weakness, low blood pressure, fast heart rate, abdominal pain, and back pain may occur. Grade 1 abruption includes mild bleeding from the vagina and uterine contractions, stable vital signs, and stable fetal heart rate. Grade 2 means moderate bleeding, abnormal contractions, low blood pressure, distressed fetus, and abnormal coagulation profile. Grade 3 is worst. It involves severe bleeding and contractions, very low blood pressure, fetal death, and very poor coagulation profile.

Treatment :Stabilization of the mother is done first. Intravenous fluids  are given to maintain blood pressure and keep the urine flow steady. An emergency cesarean section and blood transfusions may be needed. For almost full-term babies and mild abruption, vaginal delivery may be possible.

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