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As the fetal hypothalamus matures, the activation of the hypothalamic–pituitary–adrenal (HPA) axis initiates labor through two hormonal mechanisms. The end pathway of both mechanisms lead to contractions in the myometrium, a mechanical cause of placental separation, which is due to the sheer force and contractile and involutive changes that occur within the uterus, distorting the placentome.
Placental abruption occurs in about 1 in 200 pregnancies. [5] Along with placenta previa and uterine rupture it is one of the most common causes of vaginal bleeding in the later part of pregnancy. [6] Placental abruption is the reason for about 15% of infant deaths around the time of birth. [2] The condition was described at least as early as ...
Retained placenta is a condition in which all or part of the placenta or membranes remain in the uterus during the third stage of labour. [1] Retained placenta can be broadly divided into: failed separation of the placenta from the uterine lining; placenta separated from the uterine lining but retained within the uterus
Placental expulsion begins as a physiological separation from the wall of the uterus. The average time from delivery of the baby until complete expulsion of the placenta is estimated to be 10–12 minutes dependent on whether active or expectant management is employed. [ 61 ]
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
The placenta may bleed or begin to separate early from the wall of the uterus. [28] It is normal for the placenta to separate from the uterine wall during delivery, but it is abnormal for it to separate prior to delivery; this condition is called placental abruption and can be dangerous for the fetus. [29]
These signs gave him hope. After she was weaned off the breathing machine and ECMO, he talked to her, relieved by how she was doing. “Essentially, she got stronger and stronger,” he says.
Placental abruption defined as the separation of the placenta from the uterus prior to delivery, is a major cause of third trimester vaginal bleeding and complicates about 1% of pregnancies. [13] [50] Symptomatic presentations are variable: Some women can entirely ignore the symptoms, while others have mild bleeding or abdominal discomfort and ...