About Information of Placental Separation
24 December 2007What is this Condition?
In this condition, the placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, producing hemorrhage. This separation, a common cause of bleeding during the second half of pregnancy, occurs most often in women over age 35 who’ve had multiple pregnancies.
The prognosis for the fetus depends on gestational age and amount of blood lost; the mother’s prognosis is good if hemorrhage can be controlled. A firm diagnosis in the presence of heavy maternal bleeding generally requires termination of pregnancy.
What Causes it?
The cause of placental separation is unknown. Predisposing factors include trauma (such as a direct blow to the uterus or bleeding due to needle puncture of the placenta during amniocentesis), chronic or pregnancy-induced high blood pressure, having more than five children, short umbilical cord, dietary deficiency, smoking, advanced maternal age, and pressure on the vena cava from an enlarged uterus.
In placental separation, blood vessels at the placental bed rupture spontaneously because of a lack of resiliency or abnormal changes in uterine vasculature. High blood pressure complicates the situation, as does an enlarged uterus, which can’t contract enough to seal off the torn vessels. Consequently, bleeding continues unchecked, possibly shearing off the placenta partially or completely.
What are its Symptoms?
Placental separation produces a wide range of symptoms, depending on the extent of placental separation and the amount of blood that the mother loses.
Mild placental separation (marginal separation) develops gradually and produces mild to moderate bleeding, vague lower abdominal discomfort, mild to moderate abdominal tenderness, and uterine irritability. Fetal heart tones remain strong and regular.
Moderate placental separation (about 50% placental separation) may develop gradually or abruptly and produces continuous abdominal pain, moderate dark red vaginal bleeding, a tender uterus that remains firm between contractions, barely audible or irregular and slowed fetal heart tones and, possibly, signs of shock. Labor usually starts within 2 hours and often proceeds rapidly.
Severe placental separation (70% placental separation) develops abruptly and causes agonizing, unremitting uterine pain (described as tearing or knifelike); a boardlike, tender uterus; moderate vaginal bleeding; rapidly progressive shock; and absence of fetal heart tones.
In addition to hemorrhage and shock, other complications may include kidney failure and disseminated intravascular coagulation. Death of the mother and fetus may result.
How is it Diagnosed?
Diagnostic measures for placental separation include observation of signs and symptoms, a pelvic exam, and ultrasound. Decreased hemoglobin and platelet counts support the diagnosis.
How is it Treated?
Treatment of placental separation is designed to assess, control, and restore the amount of blood lost; to deliver a viable infant; and to prevent blood clotting disorders. Immediate measures include starting an intravenous infusion of appropriate fluids to offset fluid losses, monitoring fluid status, various blood studies, electronic fetal monitoring, and monitoring of maternal vital signs and vaginal bleeding.
After these measures, prompt delivery by cesarean section is necessary if the fetus is in distress. If the fetus is not in distress, monitoring continues; delivery is usually performed at the first sign of fetal distress.
Tagged under:abdominal pain, blood vessels, dietary deficiency, high blood pressure, placenta, Pregnancy Related Disorders, termination of pregnancy vaginal bleeding
