eMedicine Specialties > Obstetrics and Gynecology > Obstetrical Complications

Abruptio Placentae: Follow-up

Author: Shad H Deering, MD, Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of Washington; Medical Director, Andersen Simulation Center, Madigan Army Medical Center
Contributor Information and Disclosures

Updated: Dec 22, 2008

Follow-up

Further Inpatient Care

Admit the patient for testing and possible delivery.

Inpatient & Outpatient Medications

  • Prenatal vitamins
  • Iron supplements
  • Stool softeners if the patient is hemodynamically stable and is kept in an inpatient setting for monitoring

Transfer

  • Transfer to an ICU may be necessary, before or after delivery, if shock develops that requires invasive central monitoring or if operative complications are encountered.
  • Transfer to a facility with a neonatal ICU is needed if the fetus is preterm and appropriate facilities are not available. This should be accomplished after delivery if delivery is required to stabilize the mother.

Deterrence/Prevention

  • Elimination of correctable risk factors can decrease the risk of recurrence in subsequent pregnancies.
  • Two of the most notable correctable factors are smoking and cocaine abuse. Education about the risks of these behaviors and about cessation or rehabilitation programs may help prevent future abruptions.
  • If a patient was abused, preventing further abuse is an important consideration.
  • Because of the potential association with thrombophilias, a patient found to have a thrombophilia who had a severe or early abruption, especially with death of the fetus, is usually treated with heparin anticoagulation therapy during the following pregnancy and for 6 weeks' postpartum, though, at present, little evidence has demonstrated that this measure decreases the risk of recurrence.

Complications

  • Fetal
    • Death
    • Issues related to prematurity
  • Maternal
    • Death
    • Transfusion-related morbidity
    • Classic cesarean delivery with need for repeat cesarean deliveries
    • Hysterectomy

Prognosis

  • The risk of recurrence of abruptio placentae is reportedly 4-12%. If the patient has abruptio placentae in 2 consecutive pregnancies, the risk of recurrence rises to 25%.
  • If the abruption was severe and resulted in the death of the fetus, the risk of a recurrent abruption and fetal demise is 7%.

Patient Education

  • Educate patients about reversible risk factors, especially smoking, before further pregnancies.
  • Question the patient regarding possible trauma from abuse.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize signs and symptoms of abruptio placentae, or failure to intervene in a timely manner, can lead to medical/legal problems.
  • As with any case in obstetrics, the possibility for litigation always exists. Controversial decisions made regarding placental abruption, especially when tocolysis is considered, should be made after consultation with an MFM specialist.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Andrew Satin, MD to the development and writing of this article.



More on Abruptio Placentae

Overview: Abruptio Placentae
Differential Diagnoses & Workup: Abruptio Placentae
Treatment & Medication: Abruptio Placentae
Follow-up: Abruptio Placentae
Multimedia: Abruptio Placentae
References
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References

  1. Abu-Heija A, al-Chalabi H, el-Iloubani N. Abruptio placentae: risk factors and perinatal outcome. J Obstet Gynaecol Res. Apr 1998;24(2):141-4. [Medline].

  2. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol. Feb 10 2002;101(1):6-14. [Medline].

  3. American College of Obstetricians and Gynecologists. ACOG technical bulletin. Preterm labor. Number 206--June 1995 (Replaces No. 133, October 1989). Int J Gynaecol Obstet. Sep 1995;50(3):303-13. [Medline].

  4. Ananth CV, Smulian JC, Vintzileos AM. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies. Obstet Gynecol. Apr 1999;93(4):622-8. [Medline].

  5. Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol. Feb 15 2001;153(4):332-7. [Medline].

  6. Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol. Nov 1 1996;144(9):881-9. [Medline].

  7. Ananth CV, Savitz DA, Bowes WA Jr, Luther ER. Influence of hypertensive disorders and cigarette smoking on placental abruption and uterine bleeding during pregnancy. Br J Obstet Gynaecol. May 1997;104(5):572-8. [Medline].

  8. Anteby EY, Musalam B, Milwidsky A, et al. Fetal inherited thrombophilias influence the severity of preeclampsia, IUGR and placental abruption. Eur J Obstet Gynecol Reprod Biol. Mar 15 2004;113(1):31-5. [Medline].

  9. Clark SL. Placentae previa and abruptio placentae. In: Creasy RK, Resnik R, eds. Maternal Fetal Medicine. 5th ed. Philadelphia, Pa: WB Saunders; 2004:715.

  10. Facchinetti F, Marozio L, Grandone E, et al. Thrombophilic mutations are a main risk factor for placental abruption. Haematologica. Jul 2003;88(7):785-8. [Medline].

  11. Foley MR, Strong TH Jr, Foley MR, eds. Placental Abruption. In: Obstetric Intensive Care: A practical manual. First ed. Philadelphia, Pa: WB Saunders; 1997:35-9.

  12. Gabbe SG, Niebyl JR, Simpson JL, eds. Abruptio placenta. In: Obstetrics - Normal and Problem Pregnancies. 3rd ed. New York, NY: Churchill Livingstone; 1996:505-10.

  13. Glantz C, Purnell L. Clinical utility of sonography in the diagnosis and treatment of placental abruption. J Ultrasound Med. Aug 2002;21(8):837-40. [Medline].

  14. Hoskins IA, Friedman DM, Frieden FJ. Relationship between antepartum cocaine abuse, abnormal umbilical artery Doppler velocimetry, and placental abruption. Obstet Gynecol. Aug 1991;78(2):279-82. [Medline].

  15. Kramer MS, Usher RH, Pollack R. Etiologic determinants of abruptio placentae. Obstet Gynecol. Feb 1997;89(2):221-6. [Medline].

  16. Kujovich JL. Thrombophilia and pregnancy complications. Am J Obstet Gynecol. Aug 2004;191(2):412-24. [Medline].

  17. Kupferminc MJ, Eldor A, Steinman N, et al. Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med. Jan 7 1999;340(1):9-13. [Medline].

  18. Lockwood CJ. Inherited thrombophilias in pregnant patients: detection and treatment paradigm. Obstet Gynecol. Feb 2002;99(2):333-41. [Medline].

  19. Misra DP, Ananth CV. Risk factor profiles of placental abruption in first and second pregnancies: heterogeneous etiologies. J Clin Epidemiol. May 1999;52(5):453-61. [Medline].

  20. No authors listed. Correction: Increased Frequency of Genetic Thrombophilia in Women with Complications of Pregnancy. N Engl J Med. Jul 29 1999;341(5):384. [Medline].

  21. Oyelese Y, Ananth CV. Placental abruption. Obstet Gynecol. Oct 2006;108(4):1005-16.

  22. Pritchard JA, Mason R, Corley M, Pritchard S. Genesis of severe placental abruption. Am J Obstet Gynecol. Sep 1 1970;108(1):22-7. [Medline].

  23. Pritchard JA, Cunningham FG, Pritchard SA, Mason RA. On reducing the frequency of severe abruptio placentae. Am J Obstet Gynecol. Nov 1991;165(5 Pt 1):1345-51. [Medline].

  24. Rana A, Sawhney H, Gopalan S. Abruptio placentae and chorioamnionitis-microbiological and histologic correlation. Acta Obstet Gynecol Scand. May 1999;78(5):363-6. [Medline].

  25. Rasmussen S, Irgens LM, Bergsjo P. The occurrence of placental abruption in Norway 1967-1991. Acta Obstet Gynecol Scand. Mar 1996;75(3):222-8. [Medline].

  26. Raymond EG, Mills JL. Placental abruption. Maternal risk factors and associated fetal conditions. Acta Obstet Gynecol Scand. Nov 1993;72(8):633-9. [Medline].

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Further Reading

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Keywords

abruptio placentae, placental abruption, fetal death, maternal mortality, fetal mortality, pregnancy, parturition, pregnancy complication, cesarean delivery, cesarean section, caesarean delivery, caesarean section, c-section, C-section, c section, C section, prematurity, premature infant, Couvelaire uterus

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Contributor Information and Disclosures

Author

Shad H Deering, MD, Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of Washington; Medical Director, Andersen Simulation Center, Madigan Army Medical Center
Shad H Deering, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Bruce A Meyer, MD, MBA, Vice President for Medical Affairs, Associate Dean for Health System Affairs and Director of the Faculty Practice Plan, Professor, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical School
Bruce A Meyer, MD, MBA is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Physician Executives, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Medical Group Management Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Antonio V Sison, MD, Medical Director, Ob/Gyn Group, Robert Wood Johnson University Hospital at Hamilton
Antonio V Sison, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and Association of Professors of Gynecology and Obstetrics
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD, The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, University of Nebraska Medical Center
Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Arkansas Medical Society, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

 
 
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