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Placental Abruption

The placenta usually separates from the uterus after the birth of the baby. Placental abruption is a condition where the placenta separates from the uterine wall during the pregnancy. Placental abruption is a serious condition and can put the baby at risk. This is a medical emergency. Hypertension can sometimes lead to placental abruption. Women who have blood-clotting disorders may experience placental abruption. Women suffering from diabetes or abusing drugs are also at higher risk for placental abruption. Those women who have had multiple pregnancies are also at higher risk for placental abruption.

A pregnant woman suffering from placental abruption is likely to have abdominal and back pain. There might be rapid uterine contractions. There is tenderness in the abdomen. Uterine bleeding is often noticed. Placental abruption can occur anytime after the 20th week of pregnancy.

An ultrasound can help in locating any possible blood clot behind the placenta. It can also help in checking for any signs of fetal distress. Fetal monitoring is essential since the placenta supplies nutrients to the growing fetus. There may be decreased fetal movements. The extent of placental abruption decides the course of treatment to be followed. Partial placental abruption needs adequate bed rest and close monitoring. In cases of total placental abruption, delivery of the infant is undertaken. This is either with vaginal delivery or cesarian section. But there is a risk of premature birth and fetal death. The newborn baby could suffer brain damage due to low levels of oxygen in the blood.

Fetal Distress

When the fetus is not coping well during labor, it indicates fetal distress. Fetal distress is rare and may not occur if the mother and the fetus have been progressing well through pregnancy. The term fetal distress is normally used when the baby's oxygen supply is compromised in the uterus.

During fetal distress, the heart rate of the fetus is monitored continuously using an electronic heartbeat monitor. Symptoms of fetal distress include:

  • Mother feels decreased fetal movement
  • Meconium in the amniotic fluid
  • Increased/decreased heart beat in fetus particularly after contractions

Causes for fetal distress

  • Oxygen supply through the umbilical cord has reduced
  • Delivery is happening beyond the expected date of delivery
  • Abnormal presentation or position of fetus
  • Prolonged labor
  • Contractions are happening very fast for the mother
  • Baby size is smaller than average
  • Prolapse of the umbilical cord
  • Placental abruption, wherein during delivery fetus separates from placenta too early
  • Diabetic mother
  • Uterine rupture
  • Mother has low blood pressure in mother during delivery
  • Multiple deliveries
  • Mother is over 35 years of age while delivering the baby.

The doctor attending to the mother experiencing fetal distress may follow any of the following:
Cesarean section
Inducing labor with medication.
Vacuum extraction delivery - using a suction cup to pull the baby down the birth canal by placing the suction cup on the baby's head.
Making the mother lie down on her left side so as to ease the pressure off the blood vessels and thus the uterus.
Mother may be put on intravenous to improve fluid levels.
Mother may be put on additional oxygen to improve supply of oxygen to the fetus.

High Risk Pregnancy

A woman's medical status, lifestyle or external factors may be the cause for high risk pregnancy. Some complications are unavoidable, while the risk in some others can be minimized by the help of the gynecologist / physician. Many times complications can also occur without any warning signal. Sometimes causes and risk factors can be identified early and suitably treated.

Anemia in pregnancy: Anemia occurs when the red blood cells are too few in the body. This leads to a lowered ability of the red blood cells to carry oxygen. Since the fetus is dependant on the mother's blood anemia can cause poor fetal growth, pre term birth and low birth weight. Anemia of pregnancy, iron deficiency anemia, vitamin B 12 deficiency, anemia due to blood loss, folate deficiency anemia are some of the types of anemia during pregnancy.

Pre term labor: In high risk pregnancies more than 11% of the babies born are pre term. Pre term labor begins before completion of thirty seven weeks of pregnancy. Pre term labor may mean either uterine contractions, rupture of amniotic sac and/or cervical dilatation. Many factors can contribute to pre term labor. Some of the key factors are:

  • Maternal factors like preeclampsia, chronic medical illness, infection like urinary tract infections, vaginal infections, drug abuse, abnormal structure of the uterus, cervical incompetence, previous pre term birth.

  • Factors involving pregnancy like abnormal or decreased function of the placenta, placenta previa and abruption, premature rupture of membranes

  • Factors involving the fetus like behavior of intrauterine environment, multiple gestation and erythrobalstois fetalis which means Rh blood group incompatibility.

Intrauterine Growth Restriction (IUGR): This is a condition in which the fetus is smaller than expected for the number of weeks of pregnancy or there is fetal growth restriction. Newborn babies with IUGR are small for their gestational age. The baby's fetal weight is less than the 10th percentile. The fetus with IUGR may be born at term or prematurely. They appear thin, pale and have loose dry skin. Some have a wide eye look.

IUGR can begin at any time of pregnancy. While early onset of IUGR is due to chromosomal abnormality, late onset is due to other related problems. Although it is not possible to prevent IUGR, it can normally well managed by the doctor.

Generally the earlier and more severe the growth restriction, the greater the risk. Careful monitoring of the fetus growth is needed in all cases of IUGR. This is done by ultrasound and Doppler studies and mother's weight gain monitoring. Other ways to watch the potential high risk is by fetal movement counting, non stress testing, and biophysical profile examination.

Post term pregnancy: In contrast to pre term pregnancy, post term pregnancy lasts for more than forty two weeks. About 7% of babies are born at forty two weeks or later. Such post term pregnancies can cause longer hours of labor and operative delivery. Mothers are at increased risk for vaginal birth trauma due to large baby. Cesarean deliver is likely for post term babies.

Multiple pregnancy: Multiple pregnancy means two or more fetuses. A very small percentage (about 3%) of women experiences multiple pregnancy.

Post partum hemorrhage: This is when excessive bleeding follows the birth of the baby in the mother. About 4% of women have post partum hemorrhage. Immediate medical intervention is required to stop bleeding. Some women with placental abruption and placenta previa are more susceptible for post partum hemorrhage than others.

RH disease: This disease occurs when there is incompatibility between the blood of the mother and the baby. This again is a high risk factor in pregnancy.

Premature rupture of membranes: Premature rupture of membranes means breaking open of the membranes before labor begins, especially before thirty seven weeks of pregnancy. Nearly 10% of pregnancies suffer premature rupture of membranes.

Rupture or membranes is caused by natural weakening of membranes or from force of contractions. Low socioeconomic conditions, sexually transmitted infections, previous pre term birth, vaginal bleeding and cigarette smoking during pregnancy are some of the main causes for premature rupture of membranes. One third of the premature births suffer from premature rupture of membranes.

Gestational diabetes: Diabetes in pregnancy can have serious consequences for the mother and the fetus. The severity of the problem depends upon the degree of the mother's diabetic disease. In the US about 9 % if women have diabetes and one third of them do not know it. 2 to 3% of women develop diabetes during pregnancy called gestational diabetes. Here the mother who does not have diabetes develops a resistance to insulin because of the hormones of pregnancy.

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Collection of Pages - Last revised Date: October 19, 2017