2/20/2024 0 Comments Precipitate labour treatmentA focused history and physical is critical to differentiate placental abruption and other causes of vaginal bleeding. Placental abruption is one of the causes of vaginal bleeding in the second half of pregnancy. The classification of placental abruption is based on the following clinical findings: The clinical implications of a placental abruption vary based on the extent of the separation and the location of the separation. Placental abruption can be complete or partial and marginal or central. If the fetus does not receive enough oxygen and nutrients, it dies. When accumulating blood causes separation of the placenta from the maternal vascular network, these vital functions of the placenta are interrupted. Diffusion to and from the maternal circulatory system is essential to maintaining these life-sustaining functions of the placenta. The placenta is the fetus’ source of oxygen and nutrients, as well as the way the fetus excretes waste products. As the blood accumulates, it pushes the uterine wall and placenta apart. Placental abruption occurs when the maternal vessels tear away from the placenta, and bleeding occurs between the uterine lining and the maternal side of the placenta. This suggests a multifactorial etiology that is not well understood. In many countries, the rate of placental abruption has been increasing, even with improved obstetrical care and monitoring techniques. Neonatal consequences include preterm birth and low birth weight, perinatal asphyxia, stillbirth, and neonatal death. With the availability of blood replacement, maternal death is rare but continues to be higher than the overall maternal mortality rate. These can result in Sheehan syndrome or postpartum pituitary gland necrosis. With placental abruption, the woman is at risk for hemorrhage and the need for blood transfusions, hysterectomy, bleeding disorders, specifically disseminated intravascular coagulopathy and renal failure. The majority of placental abruptions occur before 37 weeks gestation. Placental abruption is a leading cause of maternal morbidity and perinatal mortality. ![]() Placental abruption is a relatively rare condition but requires emergent management. Therefore, when the uterine tissue stretches suddenly, the placenta remains stable, and the vascular structure connecting the uterine wall to the placenta tears away. The uterus is a muscle and is elastic, whereas the placenta is less elastic than the uterus. ![]() ![]() Disruption of the vascular network may occur when the vascular structures are compromised because of hypertension or substance use or by conditions that cause stretching of the uterus. These vascular structures deliver oxygen and nutrients to the fetus. In other words, the vascular networks connecting the uterine lining and the maternal side of the placenta are torn away. Placental abruption occurs when there is a compromise of the vascular structures supporting the placenta. Finally, trauma to the abdomen, such as a motor vehicle collision, fall, or violence resulting in a blow to the abdomen, may lead to placental abruption. Conditions specific to the current pregnancy that may precipitate placental abruption are multiple gestation pregnancies, polyhydramnios, preeclampsia, sudden uterine decompression, and short umbilical cord. Factors that can be identified during the health history that increase the risk of placental abruption include smoking, cocaine use during pregnancy, maternal age over 35 years, hypertension, and placental abruption in a prior pregnancy. Risk factors can be thought of in 3 groups: health history, including behaviors, past obstetrical events, current pregnancy, and unexpected trauma. However, a number of factors are associated with its occurrence. ![]() The exact etiology of placental abruption is unknown.
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