Let's Talk About...Placenta Abruption

November 15, 2010

Let’s talk about placenta abruption. Yes, I know, a fun topic for everyone. I just found out that a baby that survives a placenta abruption has a 40-50% chance of developing complications later on. (Not a great link to SIDS, but I have found several cases where the SIDS baby was born out of placenta abruption like Toby was.)

My OBGYN said that it was “good” that I hemorrhaged because in many cases the bleeding is internal and the woman never knew that it happened. He said that if I hadn’t bled outwardly then I would have arrived at the hospital with a “dead baby.” Oh, how wrong he was. In fact, if I had gone one more day with the pain and symptoms that I was having I was going to check myself into a hospital anyway. One that he didn’t have privileges in, such as the one that I gave birth in. You can be assured, as well, that had I arrived at the hospital with a “dead baby” he would have been one “dead doctor” and there would have been a couple of “dead midwives.” Okay, that might be extreme but by the time I finished going psycho on their asses they might wish that they were.

My aim with this blog, along with general bitching and moaning and groaning, is to help educate people who might have gone through the same thing or are going through the same thing so I like to add some factual things now and then.

At any rate, here is some medical information concerning this…

http://www.bidmc.org/YourHealth/ConditionsAZ.aspx?ChunkID=223407

Definition

Placental abruption occurs when the placenta separates from the uterus before the fetus is delivered. The placenta is the organ that provides nourishment for the fetus while it is still in the uterus. In a healthy pregnancy, the placenta remains attached to the uterine wall until after the fetus is delivered.
Some form of the condition affects about one in every 150 births. In very severe forms, placental abruption can cause death to the fetus. This occurs in approximately one in every 500-750 deliveries. Death of the mother from placental abruption is very rare. Infants who survive a birth with the condition have a 40%-50% chance of experiencing complications.

Placental abruption can cause:

• Premature delivery (Yes, 4 weeks early in my case, although my friend Chasity states that she didn’t even realize that he was early since it felt as though I’d already had the longest pregnancy ever.)
• Low birth weight (Him or me? I weighed about the same as I did when I got pregnant, thanks to the hyperemsis, once I got rid of all the excess fluid that I was retaining. He weighed a healthy 6 pounds.)
• Significant blood loss for the mother (Yes. The blood transfusion helped me get that back, though.)

Causes

The cause of placental abruption is often difficult to diagnose. Some common causes of the condition include:

• Injury to the abdomen from an accident or a fall (I think we can safely rule this out…)
• Sudden decrease in the volume of the uterus, from significant loss of amniotic fluid or from the delivery of a first twin
• Abnormally short umbilical cord
• Acute development of high blood pressure (often associated with cocaine use ) Because we all know about my coke addiction!!!

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chance of developing placental abruption:

• Previous placental abruption in a prior pregnancy
• High blood pressure during pregnancy (Hmmmm….they claim that my blood pressure was not “high.” Yet I still maintain that it was high for ME. I usually run very low so in the last week when it was elevated it might have been considered “normal” for them, but it wasn’t necessarily my normal. Be vigilant about this, ladies, and always ask what your blood pressure is when they take it. Write it down, too, and keep your own records.
• Pregnancy during older age (Does it count if you FEEL old?)
• Multiple previous deliveries (Well, I feel like I’ve had a lot, but I guess that’s not what they mean. I’m no Duggar.)
• Excessively distended uterus (Actually, this is the first time that I’ve come across this. My uterus IS distended from the adenyomiosis. I asked the doc before I got pregnant if this would be an issue. He said no.)
• Diabetes (I’m waiting my turn since both my parents and grandparents have/had it, but I’m not there yet. Mine runs low.)
• Drug use (cocaine)
• Smoking during pregnancy (I smoked. Once. In 2005 with a couple of Polish girls in New Hampshire. Afterwards, I was thrown headfirst, fully clothed into a lake. I wasn’t impressed with either activity.)
• Alcohol abuse during pregnancy (We all know about my alcohol addiction…I highly doubt that one bourbon ball during Christmas sent me over the edge.)

So the moral of this is, I had none of the risk factors except for the distended uterus and even that is up for debate. Oh, and the blood pressure.

Symptoms

In the early stages, you may not have symptoms. When symptoms occur, they may include:

• Vaginal bleeding (Uh, yeah…How about a bloody waterfall?)
• Abdominal pain (For several days leading up to the vaginal bleeding.)
• Back pain (Definitely. In fact, I even paid a visit to my neurologist who laughed me off and told me that in several weeks I would give birth and it would be fine.)
• Rapid contractions (So much so that I sweated through two sets of sheets-ours and Mom’s. When I finally went into labor, after the hemorrhaging, the contractions started at 2 minutes apart.)
• Soreness in the uterus (It all felt sore to me.)

If you have had a placental abruption then your chances of getting it again are about 10%. 

What does this mean for SIDS babies, and does it mean anything at all? According to research here, it (along with placenta previa) might have some bearing on it. 

"

Therefore, placenta

previa not only results in the reduced supply of

oxygen and nutrients to the fetus due to decreased placental

surface area, suboptimal uterine location, and

bleeding, but the presence of the condition also indicates

reduced uteroplacental oxygen and delivery of

nutrients (10). In the case of placental abruption, the

premature separation of the normally implanted placenta

will result in a decreased surface area for maternalfetal

blood exchange, thus leading to a reduced supply

of oxygen and essential nutrients. It is obvious that

both placental abruption and placenta previa could

result in or indicate a reduced supply of oxygen and

essential nutrients to the fetus. Although placental

abruption may result in acute fetal hypoxia compared

with placenta previa which more likely leads to chronic

fetal hypoxia, the effect of fetal hypoxia on fetal development,

especially on the neurologic system, in terms

of duration and intensity is not well understood (13, 16,

17). It is possible that both severe hypoxia for short

duration and chronic mild hypoxia can result in fetal

maldevelopment.

Depending on the severity of the placental abnormalities,

various damages to fetal development including

death may occur (12, 13, 18, 19). Although the

exact types of damages to live births by the placental

abnormalities during pregnancy are not well documented,

the central nervous system is probably a

potential target because of the effect of fetal hypoxia

(13, 18). A defective cardiorespiratory control system

in the brainstem has been hypothesized to be involved

in the etiology of SIDS (20-25). Therefore, it is conceivable

that some of the neurologic damage could be

severe enough, though not detectable by autopsy, to

result in SIDS when extraneous risk factors such as

prone sleeping position are present. Although the incidence

of placental abruption and placenta previa is

low, understanding the association of placental abnormality

and the risk of SIDS may enhance our knowledge

of the role of the placenta in determining the risk

of SIDS as well as other adverse pregnancy outcomes."

Rebecca’s unprofessional opinion:

If you feel like something is wrong and you are in pain, have increased swelling, or just feel like something’s off then get ye to the doctor. An ultrasound can often spot a placenta abruption before it get bad. You might get put on bedrest or you might deliver, depending on how bad it is.

Your insurance won’t cover an additional ultrasound or your doctor doesn’t think you need one? Yeah, mine was like that, too. Here is what I learned…They will almost ALWAYS give you an ultrasound if you tell them that you are bleeding-even if you’re only spotting.

Use that information as you wish.