Placental abruption

Disease Description (Causes and Symptoms)

• Definition: Placental abruption (abruptio placentae) is a pregnancy complication in which the placenta partially or completely separates from the uterine wall before delivery, interfering with blood flow and oxygen supply to the fetus and mother.
• Causes·pathophysiology: The exact cause is unclear, but hypertension (especially preeclampsia), trauma (blunt abdominal trauma), smoking·cocaine use, multiparity, premature rupture of membranes, and uterine malformations·fibroids are known risk factors. Blood infiltration between the placenta and uterine wall forms a hematoma; as separation progresses, maternal bleeding·disseminated intravascular coagulation (DIC)·fetal hypoxia may occur.
• Main symptoms:
  • Abdominal pain (severe, persistent uterine tenderness), increased uterine contractions (frequent contractions)
  • Vaginal bleeding (may be absent; concealed abruption is possible)
  • Decreased fetal movement or fetal distress (abnormal fetal heart rate)
  • In severe cases, hypotension·shock·decreased consciousness

Treatment Methods (Standard Treatment·Medications·Procedures·Precautions·Self-care)

• Basic principles: Maternal stabilization (ABC), bleeding control, and decision regarding emergency delivery (based on maternal or fetal condition)
• Emergency and inpatient treatment
  • Secure intravenous access (large-volume fluids), provide oxygen, and continuously monitor vital signs·blood volume·urine output
  • Blood typing·crossmatching and preparation for transfusion (packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate, etc.)
  • Tests: CBC, coagulation tests (PT/INR, aPTT), fibrinogen, electrolytes, liver function, blood gas, and urinalysis; narcotics·cocaine testing if necessary
  • Fetal monitoring: Nonstress test (NST), ultrasound if necessary
• Delivery decision
  • Immediate cesarean section: When the fetus is alive but abnormal (fetal distress·tachycardia·bradycardia) or the mother is unstable
  • Vaginal delivery may be possible: When both the mother and fetus are stable and labor is progressing rapidly, or when the fetus has died
  • When the gestational age is immature (preterm) and the condition is stable, corticosteroids (betamethasone·dexamethasone) may be considered for fetal lung maturation (when there is sufficient time)
• Transfusion·coagulation correction
  • In cases of severe bleeding or risk of DIC, red blood cells, FFP, platelets, and cryoprecipitate are administered as needed
  • Fibrinogen replacement (cryoprecipitate or fibrinogen products) may be considered
• Medications
  • Tocolytics (uterine relaxants) for delaying delivery are contraindicated (increased bleeding and fetal risk)
  • Uterotonics such as oxytocin are used to control postpartum bleeding
• Hospitalization·critical care: Patients with severe disease should be admitted to an obstetric intensive care unit or a unit capable of blood product management
• Precautions (including self-care)
  • Immediate medical attention is required for bleeding·abdominal pain·decreased fetal movement (emergency situations)
  • Avoid hypertension, smoking, and drug use (especially cocaine) during pregnancy, and prevent trauma
  • Postpartum monitoring: Check for bleeding, infection, and coagulation disorders
• Prognosis summary: Prognosis varies depending on the extent of abruption, timing of delivery, and maternal·fetal condition. In severe cases, maternal DIC, shock, fetal death·preterm birth may occur

Outpatient Visit Checklist (Items to Prepare and Example Questions)

• Items to prepare/bring
  • List of currently used medications (especially including anticoagulants·antihypertensive drugs)
  • Gestational age and previous obstetric records (previous delivery·miscarriage·surgery records)
  • Recent blood pressure records or test results (if available), and photos·notes taken when contractions·bleeding occurred (start time·amount of bleeding·nature of pain)
  • Records of allergies·chronic diseases (hypertension·diabetes, etc.)
• Symptom records to show the doctor during the outpatient visit
  • Time bleeding began, color (bright red·dark brown), and amount (frequency of pad changes)
  • Frequency·intensity of abdominal pain (pain scale), and whether uterine contractions are felt
  • Changes in fetal movement (including the time of the last fetal movement)
  • Recent trauma·drug exposure (especially cocaine·narcotics)

Examples of General Questions to Ask the Doctor

• "In the current situation, when and how will you decide on delivery (cesarean section vs. vaginal delivery)?"
• "Which tests and treatments are the priority for stabilizing the mother and fetus?"
• "If DIC is suspected, what treatment is needed and what is the prognosis?"
• "What measures should I take during pregnancy (blood pressure management·smoking cessation, etc.) to reduce the risk of recurrence?"

Examples of Disease-Specific Questions

• "What is the fetus's condition now (NST/ultrasound findings), and is immediate delivery necessary?"
• "According to what criteria will the transfusion·coagulation correction I need be decided, and will additional treatment or follow-up tests be needed after delivery?"