What to expect when you're expecting (210 page)

How common is it?
It occurs in less than 1 percent of pregnancies, almost always in the second half of the pregnancy and most often in the third trimester. Placental abruption can happen to anyone, but it occurs more commonly in women who are carrying multiples, who have had a previous abruption, who smoke or use cocaine, or who have gestational diabetes, a predisposition to clotting, preeclampsia, or other high blood pressure conditions of pregnancy. A short umbilical cord or trauma due to an accident is occasionally the cause of an abruption.

What are the signs and symptoms?
The symptoms of placental abruption depend on the severity of the detachment, but will usually include:

Bleeding (that could be light to heavy, with or without clots)

Abdominal cramping or achiness

Uterine tenderness

Pain in the back or abdomen

What can you and your practitioner do?
Let your practitioner know immediately if you have abdominal pain accompanied by bleeding in the second half of your pregnancy. A diagnosis is usually made using patient history, physical exam, and observation of uterine contractions and the fetal response to them. Ultrasound may be helpful, but only about 25 percent of abruptions can actually be seen on ultrasound. If it’s been determined that your placenta has separated slightly from the uterine wall but has not completely detached, and if your baby’s vital signs stay regular, you’ll probably be put on bed rest. If the bleeding continues, you may require intravenous fluids. Your practitioner may also administer steroids to speed up your baby’s lung maturation in case you need to deliver early. If the abruption is significant or if it continues to progress, the only way to treat it is to deliver the baby, most often by C-section.

What is it?
Chorioamnionitis is a bacterial infection of the amniotic membranes and fluid that surround and protect your baby. It’s caused by common bacteria such as E. coli or by group B strep (which you’ll be tested for around week 36 of your pregnancy). The infection is believed to be a major cause of preterm premature rupture of the membranes (PPROM) as well as of premature delivery.

How common is it?
Chorioamnionitis occurs in 1 to 2 percent of pregnancies. Women who experience premature rupture of the membranes are at increased risk for chorioamnionitis because bacteria from the vagina can seep into the amniotic sac after it has ruptured. Women who’ve had the infection during their first pregnancy are more likely to have it again in a subsequent pregnancy.

What are the signs and symptoms?
Diagnosis of chorioamnionitis is complicated by the fact that no simple test can confirm the presence of infection. The symptoms of chorioamnionitis can include:

Fever

Tender, painful uterus

Increased heart rate in both you and your baby

Leaking, foul-smelling amniotic fluid (if membranes have already ruptured)

Unpleasant-smelling vaginal discharge (if membranes are intact)

Increased white blood count (a sign the body is fighting an infection)

What can you and your practitioner do?
Be sure to call your practitioner if you notice any leaking of amniotic fluid, no matter how small, or if you notice a foul-smelling discharge or any other of the symptoms listed above. If you are diagnosed with chorioamnionitis, you will likely be prescribed antibiotics to wipe out the bacteria, and be delivered immediately. You and your baby will also be given antibiotics after delivery to make sure no further infections develop.

You’ll Want to Know …

Rapid diagnosis and treatment of chorioamnionitis greatly reduces the risks to both mother and baby.

What is it?
Oligohydramnios is a condition in which there is not enough amniotic fluid surrounding and cushioning the baby. It usually develops in the latter part of the third trimester, though it could show up earlier in pregnancy. Though the majority of women diagnosed with oligohydramnios will have a completely normal pregnancy, there is a slight risk of umbilical cord constriction if there’s too little fluid for your baby to float around in. Often, the condition is simply the result of a fluid leak or puncture in the amniotic sac (one you wouldn’t necessarily notice). Less commonly, a low level of amniotic fluid can suggest a problem in the baby, such as poor fetal growth or a kidney or urinary tract condition.