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What is Placental Abruption?

If you read the previous post, "His plans, not ours", I mentioned that Dr. Williams is suspicious that my bleeding was caused by a partial, or marginal placental abruption. While it's not an official diagnosis, she is proceeding as if it is, to be safe. She did explain that the placenta might be tearing from the uterine wall, but I still wanted more information. So, I turned to my trusty copy of "What to Expect When You're Expecting", which claims to be "America's Pregnancy Bible" and looked up this condition (probably better than investigating the wide world of Google). Most of what follows will be directly quoted from this text, with my thoughts and thoughts from the doctor interspersed.

What is it?
Placental Abruption is the early separation of the placenta (the baby's support system) from the uterine wall during pregnancy, rather than after delivery. If the separation is slight, there is usually little danger to the mother or baby as long as treatment is prompt and proper precautions are taken. If the abruption is more severe, however, the risk to the baby is considerably higher. That's because a placenta's complete detachment from the uterine wall means the baby is no longer getting oxygen or nutrition. 

 
So, my doctor is hopeful that this is only a slight tear and bed rest is part of "proper precautions". Dr. William's partner, Dr. Holtzman, came by today and said they want me in the hospital for a few days mostly so I am close to the OR should it turn into a full abruption. Dr. Holtzman also said that even bed rest may not prevent this condition from progressing, but it's worth a try. So far, I say it's working as it has been 48 hours and counting since my last episode.

How common is it?
It occurs in less than 1 percent of pregnancies, almost always in the second half of the pregnancy and most often in the third trimester. Placental abruption can happen to anyone, but it occurs more commonly in women who are carrying multiples, who have had a previous abruption, who smoke or use cocaine, or who have gestational diabetes, a predisposition to clotting, preeclampsia, or other high blood pressure conditions of pregnancy. A short umbilical cord or trauma due to an accident is occasionally the cause of an abruption. 


Dr. Williams admitted this part puzzled her as I don't have any of these conditions which might explain my case. I guess I just fall into the category of "[it] can happen to anyone".

What are the signs and symptoms?

The symptoms of placental abruption depend on the severity of the detachment, but will usually include:

  • Bleeding (that could be light to heavy, with or without clots)
  • Abdominal cramping or achiness
  • Uterine tenderness
  • Pain in the back or abdomen
Bleeding has been my only symptom thus far. As stated in the previous post, I am having some infrequent contractions but really no pains, until the doctor starts poking around that is!
 
What can you and your practitioner do?
Let your practitioner know immediately if you have abdominal pain accompanied by bleeding in the second half of your pregnancy. A diagnosis is usually made using patient history, physical exam, and observation of uterine contractions and the fetal response to them. Ultrasound may be helpful, but only about 25 percent of abruptions can actually be seen on ultrasound. If it's been determined that your placenta has separated slightly from the uterine wall but has not completely detached, and if your baby's vital signs stay regular, you'll probably be put on bed rest. If the bleeding continues, you may require intravenous fluids. Your practitioner may also administer steroids to speed up your baby's lung maturation in case you need to deliver early. If the abruption is significant or continues to progress, the only way to treat is to deliver the baby, most often by C-section.


Monitoring has shown that baby is not being negatively affected by the contractions, which is good. Ultrasound didn't show the abruption, so I thought it was interesting that the chances of seeing it that way are so slim. I guess it was worth the look, just in case. The ultrasound did show good fluid levels and a closed cervix which means baby is in good shape. Bed rest is my new mantra, as the text above explained and I have an IV block inserted in my arm should I require fluids or should I be rushed to the OR. The steroid shots were given yesterday morning and this morning. Man, those burned, making this kid a literal pain in the butt! Dr. Williams did warn that patients with this condition do have a higher rate of C-section. While this may not be my first choice for delivery, it's more important to do what's right for the baby.

Anyway, a few updated belly pictures should be coming soon!


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