Complications
The risk of anaemia depends on the woman's pre-bleeding haemoglobin, her pre-bleeding iron stores (which are often low in pregnancy), and the severity of bleeding.
Often preterm delivery is unavoidable. In such cases, the complications of prematurity do not differ, other than an increased risk of anaemia.
The placenta is adherent to the underlying myometrial layer of the uterus.[4]
Placenta accreta spectrum occurs in approximately 3% of cases of PP with no history of caesarean delivery.[4]
Risk of comorbid placenta accreta spectrum increases with caesarean delivery; one study found the risk to be 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or more caesarean, respectively.[4][91]
An ultrasound finding of retroplacental hypoechoic clear zone indicates a significantly increased risk for placental implantation abnormalities.[92]
Caesarean hysterectomy (or uterine artery embolisation or other interventional radiology procedures), may be necessary if there is significant postpartum haemorrhage.[89]
May arise in women with significant haemorrhage from PP.
In acute DIC, an explosive generation of thrombin depletes clotting factors and platelets. This activates the fibrinolytic system. Bleeding into the subcutaneous tissues, skin, and mucous membranes occurs, along with occlusion of blood vessels caused by fibrin in the microcirculation.
Fresh frozen plasma and/or platelet transfusions may be required.
Dependent on the degree of bleeding. Associated placental abruption increases the risk.
SIDS is slightly more common following PP.[88]
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