Prognosis

The prognosis for placental abruption depends on the severity of the abruption and the gestational age at which it occurs.[1]

Fetal prognosis

For the fetus, the prognosis depends primarily on the gestational age at which the abruption occurs, and on the degree of the abruption.[1] Cases of extremely preterm gestations and those with more than 50% separation of the placenta are associated with a high risk of perinatal death.[48][72] Abruption is also an important cause of indicated preterm birth and is associated with an increased risk of perinatal asphyxia and long-term neurodevelopmental handicap.[48][73][74][75] However, the perinatal outcome may be good in cases where the abruption is recognized promptly, and where the fetus is delivered expeditiously. The presence of skilled neonatal staff in centers with excellent neonatal facilities may make a difference to outcomes.

Maternal prognosis

The maternal prognosis is linked primarily to the severity of the abruption, particularly to the amount of blood lost and to the presence or absence of associated coagulopathy. There is an increased risk for blood transfusions, surgical and anesthetic complications, and cesarean hysterectomy.[76] Maternal outcomes are excellent in cases in which there is neither massive blood loss nor coagulopathy. There is an increased risk of abruption in subsequent pregnancies that is related to the underlying cause of the abruption.[37][77][78] Women with abruption have an increased risk for ischemic placental disease (abruption, preeclampsia, and intrauterine growth restriction in subsequent pregnancies).[11]

Women with placental abruption have an increased lifetime risk for cardiovascular and cerebrovascular disease.[79]

Subsequent pregnancies

Subsequent pregnancies should be monitored carefully.[78] One study from the Netherlands found a placental abruption recurrence rate of 5.8% in the next pregnancy.[38] It has been suggested that intensive surveillance should be commenced 3 months before the gestational age at which the previous abruption occurred.[36] However, this recommendation has not been tested prospectively, and has not been shown to be beneficial. For the most part, no interventions have been shown to be helpful. Nonetheless, the woman should be encouraged to stop smoking and drug use, if applicable. In addition, hypertension should be treated and blood pressure controlled in subsequent pregnancies.

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