Are there any predisposing factors to placental abruption?
Yes. Hypertension is the most significant risk factor; this is regardless of whether
this is pre-existing or it developed during pregnancy. Other risk factors are:
trauma, especially if it is directly to the abdomen
drug abuse, particularly cocaine
older mothers (over thirty five years).
In a significant proportion of affected mothers, no risk factor can be identified.
Does placental abruption recur?
Yes, there is a tendency for this to happen. If you have had one abruption, the risk
of this recurring in a subsequent pregnancy is one in twenty, that is about 5 per
cent. If it occurs in two consecutive pregnancies, the risk jumps to one in four,
i.e. about 25 per cent. Pregnancies following an abruption are regarded as high risk
and are managed as such.
Can an ultrasound scan diagnose placental abruption?
The diagnosis of this condition is largely clinical: that is, it depends on the symptoms
a woman has and the doctor's findings on examination.
A scan has a very small role to play in diagnosis and will miss the majority of abruption
cases. It is, however, useful in verifying the condition of the fetus when the diagnosis
is made or suspected.
A special blood test (Kleihauer) may confirm the diagnosis by identifying the presence
of fetal cells in the mother's circulation. However, this test is not specific
What is the method of delivery with pacental abruption?
This depends on several factors. If there is significant abruption and the fetus
is alive, the only option is an emergency caesarean delivery. Several factors do
influence the method and timing of delivery:
Gestational age: if the fetus is severely premature and there is no realistic chance
of survival outside the womb, a caesarean section is probably unwise, unless the
extent of bleeding makes it unavoidable.
If the bleeding is not continuous but assessment shows that vaginal delivery is
unlikely to be achieved in a reasonable space of time, then a caesarean section becomes
If the woman is already in labour and the fetal condition is stable, then vaginal
delivery may be aimed for.
If the baby is dead and the patient is stable, the strategy is usually a vaginal
delivery. If she is not already in labour, this is usually induced.