Essay Sample on Placenta Previa and Abruptio Placentae

Introduction

Antepartum hemorrhage refers to bleeding from the genital track, twenty-four weeks of the gestation period. The incidence of the case is between two to five percent of all pregnancies progressing past the twenty-fourth week of the gestation period (Viale et al., 2015). The clinical importance of placental abruption and placenta previa is significant as they are the primary causes of antepartum hemorrhage. The article explores the underlying differences between placental abruption and placenta praevia, their risk factors, incidences, and management, as well as their clinical importance.

Is your time best spent reading someone else’s essay? Get a 100% original essay FROM A CERTIFIED WRITER!

Order now

Placental previa and abruption are the commonest placental complications and the main causes of neonatal and maternal mortality and morbidity. According to Bhandari, Bhattacharya, Raja and Shetty (2014), multiple epidemiological studies have established a positive link between these placental complications and e chronic viral infection of hepatitis B (CHB), although the degree of association is varied. These findings have been relatively conflicting, with most of these studies reporting a decline of placental previa and abruption among women diagnosed with CHB infection (Anzaku & Musa, 2014). The reason behind the apparent discrepancy is the incapacity of individual studies to identify the increased risks. Therefore, the potential role of CHB in the pathogenesis of the two placental complications remains a critical but unresolved clinical aspect.

Placenta praevia is evident when the placenta is partly or completely inserted in the lower segment of the uterus. The etiology of the condition may be accidental in nature although is related to multiparity, advanced maternal age and previous damage of the uterus, particularly cesarean section. More often, the initial bleed is mild and painless even though severe. Diagnosis and screening are primarily by ultrasound. There is a dilemma on whether women with asymptomatic placenta praevia should be hospitalized. The recommended mode of delivery for pregnant women with asymptomatic placenta praevia is the cesarean section.

On the other hand, abruption placenta is hemorrhage associated with premature detachment of a normally placed placenta. Typically, the placenta develops pain in the uterus area, and the bleeding may not be linked to the initial bleeding (Viale et al., 2015). Mainly the diagnosis is clinical in nature and confirmed by the existence of a retroplacental clot following delivery. Early delivery is critical in the apparent case of abruption. When the infant is still alive and the gestation well-matched with survival during delivery, the caesarian section should be performed urgently. Conversely, vaginal delivery should be expedited when the fetus is dead. One of the complications associated with antepartum hemorrhage is the maternal shock, resulting from the elevated risk of postpartum hemorrhage. In addition, there is an increased risk of fetal hypoxia, premature delivery, and sudden fetal mortality. Specifically, the risk factors for the condition include prior placenta abruption, cigarette smoking, pre-eclampsia, and trauma.

Placenta abruption confounds approximately one percent of pregnancies and is the primary cause of vaginal bleeding in the second half of the pregnancy. Similarly, it is a crucial cause of prenatal morbidity and mortality. The maternal impact of placenta abruption is fundamentally contingent on its severity, while its impact on the fetus is subject to the gestation age and its severity. The main drivers of the condition are trauma, prior abruption, smoking, multi-fetal gestation, cocaine use, preeclampsia, hypertension, advanced maternal age, thrombophilias, preterm premature placental rupture, advanced maternal age, hydramnios, and intrauterine infections. As Macheku et al. (2015) report, the risks associated with placental previa include slowed fetal growth, preterm birth, birth defects, and abnormal placenta implantation, whereas those linked with abruption include among others stillbirth, organ damage (brain and kidney), shock and hemorrhage, and disseminated vascular coagulation (Macheku et al., 2015).

Of the fifty percent cases of abruption have resulted in fetal mortality, and its diagnosis is clinical, with the Kleihauer-Betke test and ultrasonography are of limited value. The management of the case is individualized based on the gestational age and its severity. In a case of fetal demise, vaginal delivery is the recommendable intervention, whereas intravascular coagulopathy is managed aggressively. Conservative management with a vaginal delivery as the main goal may be reasonable when abruption occurs near or at term and the fetal and maternal status are reassuring. On the contrary, the presence of maternal or fetal compromise, urgent delivery through cesarean is recommended. At the same time, abruption at preterm gestations is manageable conservatively in selected cases, with rapid delivery and close monitoring should condition deteriorate. Placental abruptions in most cases cannot be prevented or predicted although infant and maternal outcomes can be optimized through a focus on the benefits and risks of conservative management, continuous evaluation of the maternal and fetal well-being, and through speedy delivery where possible.

Conclusion

Placental previa and abruption remain an important cause of maternal and fetal morbidity and mortality. The degree of mortality is subject to the gestational age and severity of the complication. Regrettably, neither prevention nor prediction of abruption or previa is possible presently. Despite technological advances, the diagnosis of these important complications is clinical and is based on clinical symptoms and the severity of pain and bleeding. Ultrasound can also be used in the location of the bleeding, as well as to confirm the location of the fetus. There are several interventions for risk minimization and reduction of the morbidity and mortality associated with these conditions. Some of these interventions include expedited delivery and conservative management.

References

Anzaku, AS, & Musa, J. (2014). Placenta Praevia: Incidence, Risk Factors, Maternal and Fetal Outcomes in a Nigerian Teaching Hospital. (Jos Journal of Medicine; Vol 6, No 1 (2014); 42-46.) Association of Resident of Doctors.

Bhandari, S., Bhattacharya, S., Raja, E. A., & Shetty, A. (2014). Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. Bjog: an International Journal of Obstetrics and Gynaecology, 121, 1, 44-50.

Macheku, Godwin, Philemon, Rune, Oneko, Olola, Mlay, Pendo, Masenga, Gileard, Obure,

Joseph, & Mahande, Michael. (2015). Frequency, risk factors and feto-maternal outcomes of abruptio placentae in Northern Tanzania: a registry-based retrospective cohort study. (BioMed Central Ltd.) BioMed Central Ltd.

Viale, L., Allotey, J., Cheong-See, F., Arroyo-Manzano, D., Mccorry, D., Bagary, M., Mignini, L., ... , . (2015). Epilepsy in pregnancy and reproductive outcomes: a systematic review and meta-analysis. Amsterdam: Elsevier.