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Placental Abruption and Delivery

The placenta is supposed to detach from the uterine wall  after delivery of the baby. Early separation, either partial or full separation, of the placenta is called placental abruption. Symptoms of an abruption are usually pain and bleeding, followed by delivery of the baby. The pain can be mild or severe and can be in the abdomen or lower back. The placenta delivers oxygen to the baby so if an abruption is left untreated it could put the baby’s health in jeopardy. The amount of time until the baby needs to be delivered will depend upon How Much bleeding the mother is having. Once the delivery needs are determined your delivery will be scheduled.

What to Do in the Event of an Abruption

If you experience abdominal or lower back pain, vaginal bleeding, or uterine contractions you should contact your doctor immediately. NO MATTER WHAT we can describe on paper, if a pregnant woman is having symptoms which just don’t add up or if something is JUST NOT RIGHT, then call the office or go to the hospital to be evaluated. Important Phone Numbers

After an Abruption

There are TWO common questions which arise after a pregnancy is complicated by early delivery with placental abruption: ‘Why did that happen?’ and ‘Will it happen again?’ Elevated blood pressure is a common reason for an abruption. Based upon the medical details surrounding the previous delivery, there may be tests to order.  Testing falls into two categories:

Tests to Do Between Pregnancies

The tests done between pregnancies look for recurrence risk. Is there a detectable problem which increases the chance of the same complications happening again? And, can we “do something” to reduce the risk? Between-pregnancy testing may include blood tests and an ultrasound of the uterus. The blood tests look for problems with extra blood clotting, which can damage the placenta.

  1. ACA: anticardiolipin antibody (IgG and IgM which are immunoglobulins) – More Common
  2. PTT and  DRVVT – More Common
    • Some will test for lupus anticoagulant or LAC.
    • A normal PTT (partial thromboplastin time) and dRVVT (dilute Russell viper venom test) excludes LAC.
  3. Factor V Leiden: A gene test PCR (polymerase chain reaction) is used to determine whether you have Factor V Leiden, which is a mutation of one of the clotting factors in the blood called factor V (V stands for five) –  LESS Common
  4. Prothrombin gene mutation (20210) – A gene test PCR is used to determine whether you have Prothrombin gene mutation, which is a genetic variant that approximately doubles or triples the risk of forming blood clots in the veins – LESS Common
  5. AntiThrombin III deficiency – ELISA (laboratory technique) study for enzyme activity, Antithrombin III is a protein in the blood that naturally blocks abnormal blood clots from forming– LESS Common
  6. Protein S activity – should not be measured until 6 weeks after miscarriage – LESS Common
  7. Protein C activity – should not be measured until 6 weeks after miscarriage – LESS Common
  8. Hyperhomocysteinemia – a medical condition characterized by an abnormally high level of homocysteine in the blood –  LESS Common
    • Some will test for the gene mutation called MTHFR (a gene that provides instructions for making an enzyme called methylenetetrahydrofolate reductase; enzyme that plays a role in processing amino acids).
    • A normal homocysteine level excludes a problem with the MTHFR gene

Tests to Do During the Next Pregnancy

During pregnancy we look for signs that an abruption is happening again. Prenatal care may be modified, based on the test results, for the benefit of the mother and developing baby. In general, there are more ultrasounds to more carefully monitor baby growth. After 35 weeks, baby’s well being is better measured with amniotic fluid checks and extended monitoring of the heart beat.