Abruptio Placentae

Author: Shad H Deering, MD, Clinical Assistant Professor, Department of Obstetrics and
Gynecology, University of Washington; Medical Director, Andersen Simulation Center,
Madigan Army Medical Center
Contributor Information and Disclosures

Updated: Dec 22, 2008

• Print This

• Email This
• Overview
• Differential Diagnoses & Workup
• Treatment & Medication
• Follow-up
• Multimedia

• References
• Keywords

Introduction
Background

Abruptio placentae is defined as the premature separation of the placenta from the uterus.
Patients with abruptio placentae typically present with bleeding, uterine contractions, and fetal
distress. A significant cause of third-trimester bleeding associated with both fetal and maternal
morbidity and mortality, abruptio placentae must be considered whenever bleeding is
encountered in the second half of pregnancy.

Pathophysiology

Hemorrhage into the decidua basalis occurs as the placenta separates from the uterus. Vaginal
bleeding usually follows, although the presence of a concealed hemorrhage in which the blood
pools behind the placenta is possible.

If the bleeding continues, fetal and maternal distress may develop. Fetal and maternal death may
occur if appropriate interventions are not undertaken. The primary cause of placental abruption is
usually unknown, but multiple risk factors have been identified.

Frequency

United States
The frequency of abruptio placentae in the United States is approximately 1%, and a severe
abruption leading to fetal death occurs in 0.12% of pregnancies (1:830).

Mortality/Morbidity

Maternal or fetal mortality or morbidity may occur.

If an abruption occurs, the risk of perinatal mortality is reported as 119 per 1,000 people in the
United States, but this can depend on the extent of the abruption and the gestational age of the
fetus. This rate is higher in patients with a significant smoking history. Fetal morbidity is caused
by the insult of the abruption itself and by issues related to prematurity when early delivery is
required to alleviate maternal or fetal distress.

Currently, placental abruption is responsible for approximately 6% of maternal deaths. Maternal

and fetal complications include issues related to (1) cesarean delivery, (2)
hemorrhage/coagulopathy, and (3) prematurity, described as follows:

• Cesarean delivery: Cesarean delivery is often necessary if the patient is far from her
delivery date or if significant fetal compromise develops. If significant placental
separation is present, the fetal heart rate tracing typically shows evidence of fetal
decelerations and even persistent fetal bradycardia. A cesarean delivery may be
complicated by infection, additional hemorrhage, the need for transfusion of blood
products, injury of the maternal bowel or bladder, and/or hysterectomy for uncontrollable
hemorrhage. In rare cases, death occurs.
• Hemorrhage/coagulopathy: Disseminated intravascular coagulation (DIC) may occur as a
sequela of placental abruption. Patients with a placental abruption are at higher risk of
developing a coagulopathic state than those with placental previa. The coagulopathy must
be corrected to ensure adequate hemostasis in the case of a cesarean delivery.
• Prematurity: Delivery is required in cases of severe abruption or when significant fetal or
maternal distress occurs, even in the setting of profound prematurity. In some cases,
immediate delivery is the only option, even before the administration of corticosteroid
therapy in these premature infants. All other problems and complications associated with
a premature infant are also possible.

Race

Placental abruption is more common in African American women than in either white or Latin
American women. However, whether this is the result of socioeconomic, genetic, or combined
factors remains unclear.

Sex

This condition is observed only in pregnancy.

Age
An increased risk of placental abruption has been demonstrated in patients younger than 20 years
and those older than 35 years.

Clinical
History

Symptoms may include vaginal bleeding, contractions, abdominal tenderness, and decreased
fetal movement. Eliciting any history of trauma, such as assault, abuse, or motor vehicle
accident, is important. A quick review of the patient's prenatal course, such as a known history of
placenta previa, may help lead to the correct diagnosis. The patient should also be asked if she
has had a placental abruption in a previous pregnancy. Questioning the patient about cocaine
abuse, hypertension, trauma, or tobacco abuse is also crucial.

• Vaginal bleeding
o Vaginal bleeding is present in 80% of patients diagnosed with placental
abruptions.
o Bleeding may be significant enough to jeopardize both fetal and maternal health
in a relatively short period.
o Remember that 20% of abruptions are associated with a concealed hemorrhage
and the absence of vaginal bleeding does not exclude a diagnosis of abruptio
placentae.
• Contractions/uterine tenderness
o Contractions and uterine hypertonus are part of the classic triad observed with
placental abruption.
o Uterine activity is a sensitive marker of abruption and, in the absence of vaginal
bleeding, should suggest the possibility of an abruption, especially after some
form of trauma or in a patient with multiple risk factors.
• Decreased fetal movement
o This may be the presenting complaint.
o Decreased fetal movement may be due to fetal jeopardy or death.

Physical

The physical examination of a patient who is bleeding must be targeted at determining the origin
of the hemorrhage. Simultaneously, the patient must be stabilized quickly. With placental
abruption, a relatively stable patient may rapidly progress to a state of hypovolemic shock.

• Vaginal bleeding
o Bleeding may be profuse and come in "waves" as the patient's uterus contracts.
o A fluid the color of port wine may be observed when the membranes are ruptured.
• Contractions/uterine tenderness
o Uterine contractions are a common finding with placental abruption.
o Contractions progress as the abruption expands, and uterine hypertonus may be
noted.
 o Contractions are painful and palpable.
o Uterine hyperstimulation may occur with little or no break in uterine activity
between contractions.
• Shock
o Patients may present with hypovolemic shock, with or without vaginal bleeding,
because a concealed hemorrhage may be present.
o As with any hypovolemic condition, blood pressure drops as the pulse increases,
urine output falls, and the patient progresses from an alert to an obtunded state as
the condition worsens.
• Absence of fetal heart sounds: This occurs when the abruption progresses to the point that
the fetus dies.
• Signs of possible fetal jeopardy
o Fetal bradycardia is prolonged.
o Repetitive, late decelerations are present.
o Short-term variability is decreased.
• Fundal height: This may increase rapidly because of an expanding intrauterine
hematoma.
• Important note: Do not perform a digital examination on a pregnant patient with vaginal
bleeding without first ascertaining the location of the placenta. Before a pelvic
examination can be safely performed, an ultrasonographic examination should be
performed to exclude placenta previa. If placenta previa is present, a pelvic examination,
either with a speculum or with bimanual examination, may initiate profuse bleeding.

Causes

While multiple risk factors are associated with abruptio placentae, only a few events have been
closely linked to this condition, including the following:

• Cigarette smoking/tobacco abuse

o Cigarette smoking increases a patient's overall risk of placental abruption.
o A prospective cohort study showed the risk of abruption to be increased by 40%
for each year of smoking prior to pregnancy.
o In addition to the increased risk of abruption caused by tobacco abuse, the
perinatal mortality rate of infants born to women who smoke and have an
abruption is increased.
• Cocaine (powder or crack) abuse
o The hypertension and increased levels of catecholamines caused by cocaine abuse
are thought to be responsible for a vasospasm in the uterine blood vessels that
causes placental separation and abruption. However, this hypothesis has not been
definitively proven.
o The rate of abruption in patients who abuse cocaine has been reported to be
approximately 13-35% and may be dose-dependent.
• Trauma
o Abdominal trauma is a major risk factor for placental abruption.
o Motor vehicle accidents often cause abdominal trauma. The lower seat belt should
extend across the pelvis, not across the mid abdomen, where the fetus is located.
 o Trauma may also be due to domestic abuse or assault, both of which are
underreported.
• Thrombophilia
o Some literature supports the association of specific thrombophilias, such as factor
V Leiden mutation, prothrombin gene mutation (A20210 mutation),
hyperhomocysteinemia, activated protein C resistance, antithrombin III
deficiency, and anticardiolipin immunoglobulin G antibodies, and this risk may be
independent of the presence of preeclampsia. The presence of a thrombophilia
may also influence the severity of the abruption.
o Note, however, that other literature does not support an association between
thrombophilias and placental abruption. If a patient with a placental abruption is
screened and is positive for a thrombophilia she should be offered treatment with
heparin and aspirin during the next pregnancy.
• Other notable risk factors include the following:
o Previous placental abruption
o Chorioamnionitis
o Prolonged rupture of membranes (24 h or longer)
o Preeclampsia
o Hypertension
o Maternal age of 35 years or older
o Male fetal sex
o Low socioeconomic status
o Elevated second trimester maternal serum alpha-fetoprotein (associated with up to
a 10-fold increased risk of abruption)

Treatment
Medical Care

Inpatient admission is required if abruptio placentae is considered likely.

• Procedures
o Begin continuous external fetal monitoring for both the fetal heart rate
and contractions.
o Obtain intravenous access using 2 large-bore intravenous lines.
o Institute crystalloid fluid resuscitation for the patient.
o Type and crossmatch blood.
o Begin a transfusion if the patient is hemodynamically unstable after
fluid resuscitation.
o Correct coagulopathy, if present.
o Administer Rh immune globulin if the patient is Rh-negative.
• Vaginal delivery
o This is the preferred method of delivery for a fetus that has died
secondary to placental abruption.
o The ability of the patient to undergo vaginal delivery depends on her
remaining hemodynamically stable.
 o Delivery is usually rapid in these patients secondary to increased
uterine tone and contractions.

Surgical Care

• Cesarean delivery
o Cesarean delivery is often necessary for both fetal and maternal
stabilization.
o While cesarean delivery facilitates rapid delivery and direct access to
the uterus and its vasculature, it can be complicated by the patient's
coagulation status. Because of this, a vertical skin incision, which has
been associated with less blood loss, is often used when the patient
appears to have DIC.
o The type of uterine incision is dictated by the gestational age of the
fetus, with a vertical or classic uterine incision often being necessary in
the preterm patient.
o If hemorrhage cannot be controlled after delivery, a cesarean
hysterectomy may be required to save the patient's life.
o Before proceeding to hysterectomy, other procedures, including
correction of coagulopathy, ligation of the uterine artery,
administration of uterotonics (if atony is present), packing of the
uterus, and other techniques to control hemorrhage, may be
attempted.
• ICU: If the patient is hemodynamically unstable, either before or after
delivery, invasive monitoring in an ICU may be required.

Consultations

• Maternal-fetal medicine specialist

o If a mild abruption is diagnosed or the diagnosis is questionable, a
maternal-fetal medicine (MFM) specialist should be consulted.
o In the case of a preterm fetus in which tocolysis is considered likely,
consulting an MFM specialist may be prudent.
• Pediatricians or neonatal intensive care specialists should be consulted if the
fetus is considered viable, usually at 24 weeks' gestation, and delivery is
anticipated.

Diet

The patient should be restricted to nothing by mouth (NPO) if emergent delivery is a possibility.

Activity

Preterm patients diagnosed with a chronic abruption may be started on a modified bedrest
regimen and monitored closely for any signs of maternal or fetal distress that could necessitate
delivery. Again, consultation with MFM specialists is advised for conservative management of
abruptio placentae.
Medication
Tocolysis is considered controversial in the management of placental abruption and is considered
only in patients (1) who are hemodynamically stable, (2) in whom no evidence of fetal jeopardy
exists, and (3) in whom a preterm fetus may benefit from corticosteroids or delay of delivery.

Even in patients meeting these criteria, consultation with an MFM specialist is important.
Tocolysis must be undertaken with caution because maternal or fetal distress can develop
rapidly. In general, either magnesium sulfate or nifedipine (but not both) is used for tocolysis and
beta-sympathomimetic agents are avoided, as the latter may cause significant undesirable
cardiovascular effects, such as tachycardia, which may mask clinical signs of blood loss in these
patients.

Tocolytics

May allow for effective administration of glucocorticoids to the preterm fetus to accelerate fetal
lung maturation. In chronic abruption, may also help delay delivery to a gestational age when
complications of prematurity are less severe.

Nifedipine (Adalat, Procardia)

A calcium channel blocker. The theory behind use as tocolytic is that by blocking influx of
calcium into uterine muscle cells, it will decrease contractions, which are dependent on calcium.

• Dosing
• Interactions
• Contraindications
• Precautions

Adult

Loading dose: 10 mg PO q20min for up to 4 doses

Maintenance dose: 10 mg PO q4-6 h

Pediatric

Not established

• Dosing
• Interactions
• Contraindications
• Precautions
Coadministration with magnesium sulfate has potential to act in a synergistic manner with
nifedipine and enhance the hypotensive effects; fentanyl and alcohol may increase hypotensive
effects; calcium channel blocker may increase cyclosporine levels; H2 blockers (cimetidine),
erythromycin, nafcillin, and azole antifungals may increase toxicity (avoid combination or
monitor closely); carbamazepine may reduce bioavailability (avoid this combination); rifampin
may decrease levels (monitor and adjust dose of calcium channel blocker)

• Dosing
• Interactions
• Contraindications
• Precautions

Hypersensitivity to nifedipine; evidence of an acute myocardial infarction

• Dosing
• Interactions
• Contraindications
• Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may
use if benefits outweigh risk to fetus

Precautions

Potential side effects include hypotension, dizziness, nausea, pulmonary edema, reflex
tachycardia; may cause lower extremity edema; allergic hepatitis have occurred but is rare

Magnesium sulfate

DOC for tocolysis in patients with placental abruption.

• Dosing
• Interactions
• Contraindications
• Precautions

Adult

Initial dose: 4-6 g IV bolus over 20 min

Maintenance dose: 2-4 g/h IV, titrated prn to suppress contractions
Pediatric

Not established

Placenta abruptio

Images

Cesarean section

Ultrasound in pregnancy

Anatomy of a normal placenta

Placenta

Placenta

Ultrasound, normal placenta - Braxton Hicks

Ultrasound, normal fetus - arms and legs

Ultrasound, normal relaxed placenta

Ultrasound, color - normal umbilical cord

Placenta

Read More

Hypertension
Miscarriage
Diabetes
Hysterectomy

Placenta abruptio is separation of the placenta (the organ that nourishes the fetus) from the site of
uterine implantation before delivery of the fetus.

Causes

The exact cause of a placetal abruption may be difficult to determine.

Direct causes are rare, but include:

• Abnormally short umbilical cord

• Injury to the belly area (abdomen) from a fall or automobile accident
• Sudden loss in uterine volume (can occur with rapid loss of amniotic fluid or the delivery
of a first twin)

Risk factors include:

• Advanced maternal age

• Cigarette smoking
• Cocaine use
• Diabetes
• Drinking more than 14 alcoholic drinks per week during pregnancy
• High blood pressure during pregnancy -- About half of placental abruptions that lead to
the baby's death are linked to high blood pressure
• History of placenta abruptio
• Increased uterine distention (as may occur with multiple pregnancies or abnormally large
volume of amniotic fluid)
• Large number of prior deliveries

Placenta abruptio, including any amount of placental separation prior to delivery, occurs in about
1 out of 150 deliveries. The severe form, which results in fetal death, occurs only in about 1 out
of 500 to 750 deliveries.

Symptoms
 • Abdominal pain
• Back pain
• Vaginal bleeding

Exams and Tests

Tests may include:

• Abdominal ultrasound
• Complete blood count
• Fibrinogen level
• Partial thromboplastin time
• Pelvic exam
• Prothrombin time

Treatment

Treatment may fluids through a vein (IV) and blood transfusions. The mother will be carefully
monitored for symptoms of shock and the unborn baby will be watched for signs of distress,
which includes an abnormal heart rate.

An emergency cesarean section may be necessary. If the fetus is very immature and there is only
a small placenta rupture, the mother may be kept in the hospital for close observation and
released after several days if the condition does not get worse

If the fetus is developed (matured) enough, vaginal delivery may be chosen if there is minimal
distress to the mother and child. Otherwise, a cesarean section may be the preferred choice.

Outlook (Prognosis)

The mother does not usually die from this condition. However, the following increase the risk for
death in both the mother and baby:

• Absence of labor
• Closed cervix
• Delayed diagnosis and treatment of placenta abruption
• Excessive blood loss resulting in shock
• Hidden (concealed) vaginal bleeding in pregnancy

Fetal distress appears early in the condition in about half of all cases. The infants who live have a
40-50% chance of complications, which range from mild to severe.

Possible Complications
Excessive loss of blood may lead to shock and possible death in the mother or baby. If bleeding
occurs after the delivery and blood loss cannot be controlled by other means, a hysterectomy
(removal of the uterus) may become necessary.

When to Contact a Medical Professional

Call your health care provider if you are in an auto accident, even if the accident is relatively
minor.

See your health care provider immediately, call your local emergency number (such as 911), or
go to the emergency room if you are pregnant and have symptoms of this condition. Placenta
abruptio can rapidly become an emergency condition that threatens the life of both the mother
and baby.

Prevention

Avoid drinking, smoking, or using recreational drugs during pregnancy. Get early and
continuous prenatal care.

Early recognition and proper management of conditions in the mother such as diabetes and high
blood pressure also decrease the risk of placenta abruptio.

Alternative Names

Premature separation of placenta; Ablatio placentae; Abruptio placentae; Placental abruption

Placental abruption
From Wikipedia, the free encyclopedia

Jump to: navigation, search

Placental abruption
Classification and external resources
ICD-10 O45.
ICD-9 641.2
DiseasesDB 40
MedlinePlus 000901
eMedicine med/6 emerg/12
MeSH [1]

Placental abruption (also known as abruptio placentae) is an obstetric catastrophe

(complication of pregnancy), wherein the placental lining has separated from the uterus of the
mother. It is the most common cause of late pregnancy bleeding. In humans, it refers to the
abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of pregnancies
world wide with a fetal mortality rate of 20-40% depending on the degree of separation.
Placental abruption is also a significant contributor to maternal mortality.

The heart rate of the fetus can be associated with the severity.[1]

Contents
[hide]

• 1 Lasting effects
• 2 Symptoms
• 3 Pathophysiology
• 4 Risk factors
• 5 Intervention
• 6 References

• 7 External links

[edit] Lasting effects

On the mother:

• A large loss of blood or hemorrhage may require blood transfusions and intensive care
after delivery. 'APH weakens, for PPH to kill'.
• The uterus may not contract properly after delivery so the mother may need medication to
help her uterus contract.
• The mother may have problems with blood clotting for a few days.
• If the mother's blood does not clot (particularly during a caesarean section) and too many
transfusions could put the mother into disseminated intravascular coagulation (DIC) due
to increased thromboplastin, the doctor may consider a hysterectomy.
• A severe case of shock may affect other organs, such as the liver, kidney, and pituitary
gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication.
• In some cases where the abruption is high up in the uterus, or is slight, there is no
bleeding, though extreme pain is felt and reported.

On the baby:

• If a large amount of the placenta separates from the uterus, the baby will probably be in
distress until delivery. It may die in utero, resulting in a stillbirth.
• The baby may be premature and need to be placed in the newborn intensive care unit. He
or she might have problems with breathing and feeding.
• If the baby is in distress in the uterus, he or she may have a low level of oxygen in the
blood after birth.
 • The newborn may have low blood pressure or a low blood count.
• If the separation is severe enough, the baby could suffer brain damage or die before or
shortly after birth.

[edit] Symptoms
• contractions that don't stop (and may follow one another so rapidly as to seem
continuous)
• pain in the uterus
• tenderness in the abdomen
• vaginal bleeding (sometimes)

[edit] Pathophysiology
Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental
villi from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua
basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding
through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes
the blood will pool behind the placenta, known as concealed or internal placental abruption.

Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature
contractions, fetal distress or death.

Abruptions are classified according to severity in the following manner:

• Grade 0: Asymptomatic and only diagnosed through post partum examination of the
placenta.
• Grade 1: The mother may have vaginal bleeding with mild uterine tenderness or tetany,
but there is no distress of mother or fetus.
• Grade 2: The mother is symptomatic but not in shock. There is some evidence of fetal
distress can be found with fetal heart rate monitoring.
• Grade 3: Severe bleeding (which may be occult) leads to maternal shock and fetal death.
There may be maternal disseminated intravascular coagulation. Blood may force its way
through the uterine wall into the serosa, a condition known as Couvelaire uterus.

[edit] Risk factors

• Maternal hypertension is a factor in 44% of all abruptions.
• Maternal trauma, such as motor vehicle accidents, assaults, falls, or nosocomial
• Short umbilical cord
• Prolonged rupture of membranes (>24 hours)
• Retroplacental fibromyoma
• Maternal age: pregnant women who are younger than 20 or older than 35 are at greater
risk.
 • Previous abruption: Women who have had an abruption in previous pregnancies are at
greater risk.
• some infections are also diagnosed as a cause

The risk of placental abruption can be reduced by maintaining a good diet including taking folic
acid, regular sleep patterns and correction of pregnancy-induced hypertension.

[edit] Intervention
Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain
with or without bleeding. The fundus may be monitored because a rising fundus can indicate
bleeding. An ultrasound may be used to rule out placenta praevia but is not diagnostic for
abruption. The mother may be given Rhogam if she is Rh negative.

Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than
36 weeks and neither mother or fetus are in any distress, then they may simply be monitored in
hospital until a change in condition or fetal maturity whichever comes first.

Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother
are in distress. Blood volume replacement and to maintain blood pressure and blood plasma
replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over
caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of
disseminated intravascular coagulation. Patient should be monitored for 7 days for PPH.
Excessive bleeding from uterus may necessitate hysterectomy if family size is completed.

Abruptio Placentae
WHAT YOU SHOULD KNOW

The placenta (afterbirth) is the tissue that joins a mother to her developing baby. It supplies
food and oxygen to the baby and removes waste and carbon dioxide. It normally remains
attached to the wall of the uterus (womb) until the baby is delivered. Abruptio (ab-RUP-she-
oh) placentae (pla-SEN-tee), also called placental abruption, occurs when the placenta
breaks away from the uterus ahead of time. The problem can occur anytime between the
20th week of pregnancy and the beginning of delivery. All or only part of the placenta may
break away from the uterus. Placental abruption can be dangerous for both you and the
baby. You could lose a lot of blood, and the baby could die from lack of food and oxygen.

Causes

The exact cause is not known; but high blood pressure, heart disease, and arthritis make it
more likely. A trauma such as a car accident or a fall may trigger the problem. Cocaine
abuse increases the risk.

Signs/Symptoms
Signs typically include vaginal bleeding and pain in the abdomen or back. You could have
uterine contractions, with your abdomen tightening and relaxing as it does when you are in
labor, or remaining tight all the time.

Care

You may need a test called an ultrasound. This painless procedure uses sound waves to build
an image of the baby on a TV-like screen. Medicine to stop contractions may be necessary if
you are not ready to deliver. If the abruption is small, bed rest may be all that's needed. If
it's large, you may need to stay in the hospital for several weeks, and the baby may have to
be delivered early.

Risks

If you are bleeding heavily, the problem could be fatal for you or the baby. But with proper
medical care, the danger of death is small.

WHAT YOU SHOULD DO

• To reduce bleeding, bed rest is very important.

•
o Get out of bed only to use the bathroom and to bathe or shower. Do not
cook, do other household chores, or use stairs.
o Do not lift anything heavy---including your children.
• Bed rest can be boring and stressful. Reading, writing, crafts, TV, music, or visiting
with friends and family will help pass the time. Remember that resting is important
for your own safety and the health of the baby.
• Do not have sex until your doctor says it is OK.
• Eat healthy foods from all the 5 food groups: fruits, vegetables, breads, dairy
products, meat and fish. A healthy diet is especially important in this situation, both
to keep up your own strength and give the baby adequate nutrition.
• Take any medicine your doctor prescribes exactly as directed. If you feel it is not
helping, tell the doctor, but do not stop taking it on your own.

Call Your Doctor If...

• You are having contractions.

• Your baby is moving less than usual.

Seek Care Immediately If...

• You have vaginal bleeding.

• You have bad abdominal pain.
• You feel faint or are too weak to stand up.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Taking Vital Signs: These include your temperature, blood pressure, pulse
(counting your heartbeats), and respirations (counting your breaths). A stethoscope
is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a
cuff around your arm.
• Pulse Oximeter: You may be hooked up to a pulse oximeter (ox-IM-uh-ter). This
device is placed on your ear, finger, or toe. It measures the oxygen in your blood.
• Blood Tests: You may need to give blood samples for various tests. The blood can
be taken from a vein in your hand or from the bend in your elbow.
• IV: A tube placed in your vein for giving medicine or liquids. It will be capped or have
tubing connected to it.
• Activity: You will need to stay in bed to help stop the bleeding and rest your uterus.
Until the bleeding stops, you may have to use a bedpan or bedside commode instead
of getting up to use the bathroom. The doctor will tell you when it's OK to get out of
bed.
• Blood Transfusion: If you have lost a lot of blood or have a case of anemia (lack of
red blood cells), you may need a transfusion. Although you may be worried about
catching AIDS or hepatitis from a blood transfusion, the chance of this actually
happening is about 1 in a million. Usually the risks from blood loss are far greater
than your chance of getting either of these diseases.
• Abdominal Ultrasound: The doctor will probably take a look at your uterus with this
painless device.
• Fetal Heart Monitoring: A loose fitting belt with a small metal disc may be placed
around your abdomen to monitor the baby. The disc sends signals to a TV-like screen
that shows a tracing of the baby's heartbeat.
• Pelvic Exam: This is also called an "internal" or "vag" exam. The doctor begins by
gently putting a warmed speculum into your vagina. This tool opens the vagina so
your doctor can see your cervix (the exit from your uterus). With gloved hands, your
doctor will check the size and shape of your uterus and ovaries. Another woman
usually stays in the room during the exam. If one isn't present, you should feel free
to ask for one.
• Vaginal Bleeding: This could be a sign that more of the placenta is breaking away
from the uterus. Call your nurse immediately.
• Contractions: If your abdomen begins feeling tight, then loose, you're having
contractions, and could be going into labor. Tell your doctor immediately. Also let the
doctor know if your abdomen always feels tight.
• Delivery: If the detached placenta is only partially blocking the birth canal, you may
be able to have a vaginal delivery. But you'll need a cesarean section (C-section) if
the placenta is totally blocking the birth canal. A C-section will also be necessary if
the baby is in danger.
• Medicines:
• Antibiotics: These medicines help you fight bacterial infection. They are given by IV,
as a shot, or by mouth.
• Stool Softeners: You may be given stool softeners to prevent constipation. They will
make bowel movements easier.
• Tocolytics (to-ko-LIH-tiks): This medicine will stop contractions if it's too soon for
delivery. It can be given by IV, as a shot, or by mouth.
• Steroids: This medication may be given to help the baby's lungs. It also reduces
inflammation (redness and swelling).

• Stress: This is a highly stressful situation. Talking about it will help ease the tension.
You might also want to try such methods as deep breathing, muscle relaxation,
meditation, or biofeedback. Ask your nurses for directions.