This serious complication in the latter part of pregnancy is associated with vaginal bleeding. The placenta. or afterbirth, becomes partly or entirely detached from the lining of the womb before the baby is born. The separation usually occurs suddenly, hence, the name abruptio placentae (abruption of the placenta). which is descriptive of the onset of symptoms. The British refer to it as accidental hemorrhage, pointing up the fact that it comes on unexpectedly. Premature separation of the placenta occurs in something like one case in its deliveries.
In most cases the separation is not complete and the outlook for both the mother and baby is excellent. When as much as one-third or one-half of the placenta becomes detached, it is often fatal to the baby because he is deprived of the life-sustaining oxygen supplied by the placenta. Major degrees of placental separation are dangerous to the mother too, be-cause severe hemorrhage may ensue. A rare complication of premature separation of the placenta occurs
when fibrinogen, an element in the formation of blood clots, is depleted from the blood. When this happens, fibrinogen must be administered to the mother to prevent the development of a hemorrhagic tendency. In addition to their vaginal bleeding. many (hut not all) women with separations will have rain in either the abdomen or back.
The pains are like labor pains because they arise in the womb. With major separations the abdomen is hard and tender to the touch, the pain severe and unremitting. The pain in lesser degrees of separation may be no worse than a generalized backache, such as sometimes accompanies menstruation. Some women will have high blood pressure or protein in the urine or both, but a majority will not. One occasionally comes on a patient with separation who has separated the placenta in a previous pregnancy.
No one knows the cause of this condition, but recent work from England suggests it may be associated with the failure in some individuals to absorb or to utilize folic acid, a vitamin like substance needed in the formation of all cells. During the active metabolism of pregnancy. there is an increased need for folk acid. Women with premature separation have to be hospitalized. A number of laboratory tests are usually in order to determine the blood count and SO forth.
One of the difficult things for the doctor to determine is whether the bleeding is due to a premature separation of the placenta or the condition known as placenta previa In the latter complication the placenta is attached too close to the neck of the womb. There are tests that help in locating the position of the placenta. Often an internal examination is clone under anesthesia so that immediate Caesarean section can he performed if a placenta previa is encountered.
Most patients with premature separation of the placenta can be delivered safely through the vagina, and therefore labor is induced and allowed to proceed normally. When labor does not progress satisfactorily in a premature separation, a Caesarean section will be done if there are signs of fetal distress or continuance of the separation.