Placental Abruption

is the premature separation of the placenta from the site of uterine implantation before delivery of the fetus. The placenta is an organ that grows in the uterus during pregnancy to provide nourishment and oxygen to the baby. The excessive loss of blood that can result from a placental abruption may lead to shock and possible fetal death. Placental abruption resulting in fetal death occurs in about 1 out of 500 to 750 deliveries. In the United States, as many as 22 children are born still every day as a result of placental abruption. If the baby survives, he or she may suffer from brain damage. If the site of placental attachment starts to hemorrhage after the delivery and the loss of blood cannot be controlled by other means, a hysterectomy (removal of the uterus) may become necessary. Although maternal mortality is uncommon as a result of placental abruption, a delayed diagnosis and treatment are unfavorable factors that may increase the risk of maternal or fetal death.

There are several factors that place the mother and fetus at risk of placental abruption. These risk factors include:

• a past medical history of placental abruption
• hypertension or high blood pressure during the pregnancy (hypertension is present in approximately 50% of placenta abruption cases that result in fetal death)
• increased maternal age
• increased number of prior deliveries
• increased uterine distention
• diabetes mellitus in the pregnant woman
• cigarette smoking
• cocaine abuse and
• drinking significant amounts of alcohol during pregnancy

Among the symptoms and warning signs of the occurrence of placental abruption are:

• Vaginal bleeding
• Abdominal pain
• Contractions that do not stop and
• Back pain

In the presence of risk factors, symptoms, or warning signs, a physician can conduct a number of tests to rule out placental abruption. These include a physical examination of the mother to determine whether uterine tenderness and/or increased uterine tone. Hemorrhage or heavy bleeding in pregnancy may be visible. In addition, certain tests can be performed, such as:

• A CBC, which may note decreased hematocrit or hemoglobin and platelets
• Prothrombin time test
• Partial thromboplastin time test
• Fibrinogen level test
• Abdominal ultrasound to look for blood clots
• Nonstress test to look for signs of fetal distress

The treatment of placental abruption includes IV (intravenous) fluid replacement, blood transfusion, and careful monitoring of the mother for signs/symptoms of shock and for signs of fetal distress (a condition in which the fetal heart rate becomes too high or too low, or in which there are abnormal fetal heart rate changes in relation to contractions). An emergency cesarean section may be necessary for fetal distress or maternal bleeding. In the event of an immature fetus and evidence of only a small placental separation, the mother may be hospitalized for observation and released after several days if no evidence of progressing abruptio occurs. When the fetus is mature, vaginal delivery may be chosen if maternal and fetal distress is minimal; otherwise, a cesarean section may be the preferred choice to protect the mother and the child.

If a physician or other health care provider failed to monitor for a placental abruption or failed to take appropriate measures following a placental abruption, resulting in injury or death to the child and/or mother, you should immediately contact a competent lawyer. The lawyer will be able to help you understand whether the injury to the child or mother was the result of a health care provider's negligence, in which case the lawyer will also be able to assist you in exploring legal action.