What is the difference between placental abruption and placenta previa

Early involvement of the multidisciplinary care team may be required for central venous pressure line insertion and monitoring, massive blood transfusion specialists or renal team and neonatal care team as appropriate.

Rhesus immunoglobulin is administered to Rh negative women if indicated. For all cases of obstetric hemorrhage, use of evidence-based standards like obstetric safety bundles and hemorrhage protocols to optimize maternal and neonatal outcomes are highly encouraged.

Pregnancies complicated with abruptio placenta below 34 weeks may be managed conservatively if mother and fetus are stable. Unless contraindicated, tocolytics may be considered only during administration of antenatal corticosteroids. When conservative care is offered, plans should be put in place for emergency delivery or delivery at or near term. The timing and route of delivery is determined by fetal and maternal stability.

Maternal or fetal compromise mandates immediate delivery, usually by cesarean. Immediately delivery is recommended if the patient is unstable patients, there is non-reassuring fetal status or after 34 weeks of gestation. In severe cases, delivery should be realized via emergency cesarean section unless the patient is in advanced labor.

For vaginal delivery, early amniotomy and, if needed, oxytocin can be administered to expedite delivery. Vaginal route, unless contraindicated or the mother is hemodynamically unstable, is recommended for all cases of fetal death.

Although maternal mortality remains low 0. Patients with placental abruption may present with hypovolemic shock which may lead to acute tubular necrosis, acute cortical necrosis or acute kidney injury and consumptive coagulopathy due to procoagulant consumption from intravascular activation of clotting factors.

Women with consumptive coagulopathy have elevated fibrinogen, and prolonged prothrombin time and partial thromboplastin time. These complications are more frequent in women with massive, and especially concealed, abruption. Extravasation of blood into uterine myometrium and subserosa due to uteroplacental apoplexy results in couvelaire uterus. Blood may also extravasate into the broad ligaments, ovaries, and free in the peritoneal cavity. Although a concern due to uterine hypotony, couvelaire uterus is not an indication for hysterectomy.

Severe grades of abruptio placenta may lead to Sheehan syndrome which may affect all pituitary hormones leading to varying degrees of failed lactation, amenorrhea, breast atrophy, loss of pubic and axillary hair, hypothyroidism, and adrenal cortical insufficiency.

Abruptio placenta may lead to preterm birth and related sequelae, non-reassuring fetal status or even worse fetal demise, and CAOS. Placenta previa and abruptio remain the major leading causes of antepartum hemorrhage, with varying degrees of maternal and perinatal morbidity and mortality. Painless or painful vaginal bleeding is the hallmark of placenta previa versus abruption. Identification of risk factors may further guide the most likely diagnosis and antecedent complications.

Patients with suspected placenta abruptio or placenta should be admitted for comprehensive evaluation and stabilization. Delivery is planned at or near term for stable patients but earlier for cases for severe bleeding. There is need for continued training and mentorship of midwives and other cadres of obstetric care team on management protocols, algorithms and referral processes for patients with placenta previa and abruption. For quick clinical decision-making, bedside ultrasound training and resources should be available for labor ward staff to help triage patients with suspected placenta abruptio or previa.

Centers of excellence in management of placenta previa and morbidly adherent placenta are needed to avert adverse outcomes associated with lower level of skill and experience. Local and regional blood transfusion services and well equipped and trained local laboratory personnel are required and essential for averting adverse maternal and perinatal outcomes associated with placenta previa and abruptio. Pregnant women with vaginal bleeding require prompt and comprehensive maternal and fetal evaluation.

Therefore, all women with suspected placenta abruptio and placenta previa should have clear documentation on the evaluation, potential final diagnosis and management plan. For unstable and preterm pregnancies referral to more equipped facilities should be made early and clearly documented.

Health systems should be equipped to identify risk factors for these pregnancy complications and where possible administer prevention interventions like folic acid and folate supplementation and reducing unnecessary primary cesarean sections.

In line with the recent World Health Organization Antenatal Care Guidelines, routine one obstetric ultrasound after 20 weeks may identify subclinical cases of placenta previa or abruptio. In tertiary and better-equipped health facilities, all pregnant women with placenta previa and abruption should be closely monitored while aiming at timely delivery and identification of potential complications from severe bleeding such as acute kidney injury and coagulopathy. Furthermore, when delivery is indicated anticipation and management of potential intrapartum including intraoperative complications should be prioritized.

Health facilitie,s where women with placenta abruptio and previa deliver, should undergo regular auditing of care and outcomes in order to increase identification and management. For example where morbidly adherent placenta is not diagnosed until intrapartum or postpartum, such reports can improve the quality of ultrasound imaging and reporting. In addition, if severe maternal outcomes arise from lack of blood products, blood transfusion infrastructure can be strengthened to improve outcomes.

Just like antepartum and intrapartum care, postpartum care after deliveries complicated with placenta previa and abruption is critical in preventing further deterioration of maternal condition and newborn care.

Therefore, facilities should be equipped with maternal critical care and newborn intensive care units to handle postpartum and newborn complications. Where these services are not available, clear referral mechanisms must be identified. Counseling of mothers and their families should be prioritized especially where severe morbidity and mortality occurs. Debriefing mechanism for health care providers should also be availed. Finally, advocacy, awareness and legal framework are required to increase awareness and accountability when taking care of women with placenta previa and or abruption.

Women and families should know their rights and advocate for proper physical and financial access to skilled health care provision.

Also, because preterm birth or severe maternal hemorrhage may be accompanied by huge financial costs, health systems should consider cost alleviation. In conclusion, health facilities offering care for pregnant women with placenta previa and abruptio must be should be equipped to evaluate, diagnose, refer and comprehensively take care of the patients from diagnosis to the postpartum period. Health systems should consider the supportive care from laboratory and blood transfusion services as well as cost implication following severe morbidity or mortality related to placenta abruptio or previa.

Community participation, advocacy and awareness are key to addressing the first and second delays in care. Audits and reviews after deliveries complicated by placenta previa and abruptio can help identify and address factors associated with the third delay.

The authors of this chapter declare that they have no interests that conflict with the contents of the chapter. So if you have any constructive comments about this chapter please provide them to us by selecting the "Your Feedback" link in the left-hand column.

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Placental abruption and placenta praevia. Eur Clinics Obstet Gynaecol 2, — Download citation. Received : 15 July Accepted : 21 August Published : 01 November Issue Date : November Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. However, the placenta plays a critical role in the development of your baby, allowing you to provide nutrition to the baby and remove waste products. While relatively rare, problems can arise with the placenta that can complicate your pregnancy or delivery.

One of the important pieces of information gained from your week ultrasound is the position of your placenta. The placenta usually forms along the front anterior or back posterior wall of the uterus, up and away from the cervix, the opening to the uterus. However, in approximately 1 out of every births, the placenta blocks the opening of the cervix, a condition known as placenta previa.

Occasionally, placenta previa can result in vaginal bleeding in the second or third trimester, which is usually painless and bright red in color. If a vaginal delivery is attempted, the placenta can tear, leading to very heavy bleeding peripartum hemorrhage , which can endanger the life of both the mother and baby.

For this reason, women with placenta previa diagnosed by ultrasound are scheduled for delivery by cesarean section. The good news is that most cases of placenta previa seen on the week ultrasound resolve on their own; as the uterus continues to grow, the placenta moves up and away from the opening to the cervix, allowing for a safe vaginal delivery.

If a placenta previa is seen on your initial ultrasound, your doctor or midwife will follow you a bit more closely, checking the position of the placenta later in pregnancy to see if a c-section might be a safer option for your delivery. The occurrence of placenta previa was 1. The effects of maternal age, race, parity, and previous cesarean section were stronger on placenta previa than on placental abruption, and the effects of cigarette smoking, alcohol drinking, and prenatal care were stronger on placental abruption than on placenta previa.