Your placenta is your baby's lifeline, supplying her with nutrients, carrying away waste, and keeping her growing and developing. Any disruption to that lifeline could have negative implications, ranging from developmental delays to miscarriage. And that's why placental abruption--when the placenta detaches in part or in full from the uterus--can be one of pregnancy's more frightening complications. It might not happen to you, but it is important to know that it could: One out of every 100 to 150 pregnancies is affected by placental abruption.
Here's what you need to know about this pregnancy complication.
"High blood pressure can lead to an abruption," says Titi Otunla, a certified nurse midwife at Texas Children's Pavilion for Women in Houston. "Any change in the pressure in the uterus can cause an abruption, so hypertension in a pregnant woman could put her pregnancy at high risk." If you do have high blood pressure, your doctor will likely put you on medication to try to keep your blood pressure in check. "Preeclampsia can also be a factor," says Marra Francis, M.D., an ob-gyn in Woodlands, Texas, and an author of the Mommy MD Guides. "That's why it's very important to not skip your doctor's visits to check your blood pressure and check for protein in your urine."
"The substances you ingest could interfere with the development of the placenta," Dr. Francis says. "The substances most commonly associated with placental abruption are cocaine, crack, excessive drinking--typically more than 15 drinks per week--and smoking."
"Abruption can happen if you've been in a car accident or you've had a fall, especially in the third trimester," Otluna says. Any trauma to the abdomen could cause an abruption." In fact, abruption is pretty rare early in the pregnancy. More abruptions happen later in the pregnancy, when your distended uterus is less protected. "Your uterus stretches so much that the placenta can actually start to tear away," Dr. Francis says.
Many issues, including how large the tear is and how far along you are in your pregnancy, come into play when deciding the course of treatment for an abruption. "The risk depends on how severe the abruption is," says Siobhan Kubesh, a certified midwife with OB-GYN North in Austin. "If a small edge comes undone, it's almost like a scab lifting up, with a little bit of bleeding. But if it's a larger portion, there's severe bleeding and [that] warrants an immediate C-section," Dr. Kubesh says. Your doctor will assess your condition and your baby's health to see how to deal with the abruption. "It depends on how much bleeding there is and the state of the baby," Dr. Francis says. "If the baby's starting to show signs of lack of oxygen, which we can tell with a nonstress test or an ultrasound, you can see how Baby is adjusting to having this placenta torn away. Most often, though, treatment involves delivering the baby, usually by emergency C-section."
"Sometimes, the abruption is concealed--it's so high up in the uterus that they don't ever bleed, so they don't realize they've had the abruption," Dr. Francis says. "But that baby could be at risk of cerebral palsy, due to the lack of oxygen caused by the abruption." Sometimes the abruption can be discovered during an ultrasound. "Ultrasound technology has gotten so good that you can see changes in the placenta while in utero," Dr. Francis says. "If a part of the placenta is so scarred that there's no normal blood flow, it appears bright white in the ultrasound, and we can document that." Your ob-gyn can let the pediatrician know that your baby may be at risk for certain developmental delays as a result of the abruption so that your baby will be closely monitored and helped to achieve her milestones.
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