Complications
Blood loss in abruption may be concealed, resulting in greater blood loss than is recognized. Shock is an important complication of abruption. Recognition of shock and prompt treatment are crucial to avoiding maternal morbidity and possibly death.
Signs of shock include hypotension, tachycardia, and reduced urine output.
Management involves volume replacement and administration of blood and blood products.
Results from consumption of coagulation factors. Occurs most frequently in cases of abruption associated with fetal death. May also occur with concealed abruptions.
May lead to massive blood loss and need for transfusions. May also lead to ICU admission.
Diagnosed if blood does not clot promptly, or by laboratory studies indicating prolongation of the clotting time, prothrombin time, or activated tissue thromboplastin time, as well as abnormally low levels of fibrinogen.
Treated with fresh frozen plasma or cryoprecipitate. Consultation with a hematologist/blood bank is recommended.
Women with abruption frequently present acutely with hemorrhage and fetal distress, necessitating urgent cesarean delivery under general anesthetic with endotracheal intubation.
These women are at increased risk of aspiration pneumonitis and other anesthetic complications. Also, the urgent delivery leads to increased risk of surgical complications, including visceral injury, infection, and hemorrhage.
Frequently associated with intrauterine growth restriction.[76]
Associated with an increased risk for periventricular leukomalacia, cerebral palsy, and neurodevelopmental delay.[75]
Associated with an increased risk of preterm birth (adjusted relative risk 3.9; 95% CI 3.5 to 4.4). Thrombin is a powerful uterotonic agent, and intrauterine bleeding may lead to uterine contractions and preterm labor. In addition, bleeding may weaken the chorioamniotic membranes, predisposing to preterm premature rupture of the membranes.[80]
Greatly increases the risk of perinatal death, particularly at preterm gestations.
Abruption may lead to acute tubular necrosis from hypovolemic shock, or to acute cortical necrosis from renal damage due to blood breakdown products.
Most women recover although acute cortical necrosis may result in chronic renal failure.
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