Questions about placental abruptions

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caryn
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Re: Questions about placental abruptions

Postby caryn » Wed Oct 31, 639240 9:13 am

Yes, preeclampsia patients are at heightened risk of abruption in that pregnancy and in future pregnancies. The reason's that there's something off about placental embedment - the spiral arteries aren't remodeled to the depth and breadth of a normal pregnancy - so the placenta is shallowly implanted and easier to detach, plus the failure of induction of maternal tolerance means that things are even more precarious. Labor is what happens when maternal tolerance fails at the end of pregnancy, and placental detachment is triggered by some of the biochemical processes involved. We may not be in labor, but some of the same cascades are happening in the background.

LDA/Lovenox/etc. may alter some of the cascades here but probably not the really critical ones. Clotting isn't the only thing that predisposes to labor, kwim?
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
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Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

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kerisue
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Re: Questions about placental abruptions

Postby kerisue » Tue Oct 30, 639240 12:23 am

Keri, the more rational part of my brain wishes I knew more about the study design. It was a cohort study, but I wonder what their inclusion and exclusion criteria were. I'd like to know if any, all, or none of the participants had interventions like LDA, Lovenox, etc. That makes a huge difference in the outcome of the study. Clearly, the interpretation of the conclusion of the study is highly dependent on those inclusion and exclusion criteria.
you know, with over 300,000 in the study I assumed that they were using the birth registry data and the at the only inclusion criteria were preeclampsia in a previous pregnancy, and then a subsequent pregnancy. which would mean this data would cover women who were treated with something in their 2nd pregnancy and those who weren't. but I don't know! I probably can't get the whole article, my source has a 12 mos. embargo on full text articles and not every journal is available online.

even though that one study said women with prior pe have a doubled risk, I believe the overall risk is still pretty low. (of course, all of us have already fallen prey to the odds once :( )
Mama to Millie
born June 2010 @ 24 wks. gestation due to my severe PE and CHF
lived 25 days, loved and missed

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danielsmom
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Re: Questions about placental abruptions

Postby danielsmom » Sat Oct 20, 639240 5:42 pm

To speak to the risk of bad outcomes the 2nd time around... my MFM put it this way: Yes, you have greater risk than the normal Jane without any history. BUT, some of that risk is offset by the fact that your second pregnancy should be better than the first.
Miscarriage Feb 05 & Dec 07
Daniel born Feb 09 at 27w5d, 1 lb 1 oz/12 inches (severe IUGR) due to Severe Pre-E & HELLP. Now tall for age and no complications.
Diagnosed with MTHFR
Cornual Ectopic miscarriage Mar 11
Natalie born 6-5-12 at full term, 7 lb 11 oz & 21.5 inches, progesterone 2-8 weeks (for suspected luteal phase defect), lovenox 6-29 weeks, lda 0-36 weeks, folic.

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riehlism
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Re: Questions about placental abruptions

Postby riehlism » Sat Oct 20, 639240 2:54 pm

Keri, the more rational part of my brain wishes I knew more about the study design. It was a cohort study, but I wonder what their inclusion and exclusion criteria were. I'd like to know if any, all, or none of the participants had interventions like LDA, Lovenox, etc. That makes a huge difference in the outcome of the study. Clearly, the interpretation of the conclusion of the study is highly dependent on those inclusion and exclusion criteria.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

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riehlism
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Re: Questions about placental abruptions

Postby riehlism » Sat Oct 20, 639240 9:46 am

I have no underlying disorders. So that is also not a concern. I went as far as getting a bone marrow biopsy (soooo painful) and everything came back normal.

I guess I'm just gonna have to hold on tight to my LDA and cross my fingers.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

rachelc
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Re: Questions about placental abruptions

Postby rachelc » Sat Oct 20, 639240 9:35 am

Have you ever been tested for thrombophilias while you were pregnant? I do not have any clotting issues outside of pregnancy but, for some reason have had low protein s and protein c during two of my pregnancies. I was never tested during the first so its possible that it happened them too. Maybe you should ask to be tested at some point during the pregnancy.

jules2
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Re: Questions about placental abruptions

Postby jules2 » Sat Oct 20, 639240 4:27 am

My Alice was a similar size to your son - mildly growth restricted (I had got a week further) but nothing very severe and no-one was very worried until she died. I had a placental abruption in that pregnancy which was not why she finally died but obviously a contributory factor.

I also had no underlying disorders identified and took LDA & calcium supplements in my subsequent pregnancy - which worked out very well. I think the truth is this is out of your control and its just a waiting game now ... which is so hard to accept you just want to do something whether it will help or not. Try to remember that the statistics are still very much on your side - hoping for the best for you x
May 2009 - Alice stillborn at 26 weeks due to severe PE and HELLP post-partum

2 early miscarriages

And then 4th pregnancy baby girl due 29th December 2010! Born safely after totally normal pregnancy on 17th December.

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riehlism
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Re: Questions about placental abruptions

Postby riehlism » Tue Oct 09, 639240 1:48 am

With my son, he was he was 12.25", 1lb 7oz, at 24+6, and 800g.

Below is the fetal average at 25 weeks

25 weeks 13.62 inches 1.46 pound 34.6 cm 660 grams

http://www.babycenter.com/average-fetal ... ight-chart

I didn't have growth restriction problems with him. So I know I shouldn't worry too much about that. But I'm a worrier and that is going to make the next few months rough on me.
Jasmin: Severe PE/HELLP and delivered at 24+6 & PCOS (29) Hubby Bubby, Frank (29)
Baby Blue stopped in to say hello and goodbye on 6/3/10
Baby Lucas was born on 10/13/11, PE and HELLP-free! Thank you baby aspirin and Lovenox
http://www.ehd.org/pregnancy-calendar.php?id=18192

angieb
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Re: Questions about placental abruptions

Postby angieb » Mon Oct 08, 639240 3:53 am

There was another study that KeriSue posted where lovenox/heparin was indicated to help even in women without thrombophilias:
Low molecular weight heparin (LMWH) treatment has been recommended for pregnant women with previous adverse pregnancy and who were diagnosed as having a thrombophilia. We now examined the effect of LMWH on pregnant women without thrombophilias who had severe pregnancy complications and placental vasculopathy in an earlier pregnancy. Seventy-two women with a history of severe preeclampsia, fetal growth restriction (FGR) less than fifth percentile, severe placental abruption and/or stillbirth after 20 weeks, whose thrombophilia workup was negative, were enrolled. Placental vasculopathy was defined as villous infarcts, fibrinoid necrosis of decidual vessels, fetal vessel thrombosis, evidence of placental abruption and perivillous fibrin deposition. The study group consisted of 32 pregnant women who were treated with LMWH and 40 pregnant women who were not treated with LMWH (control group) in their ensuing pregnancy in our institution between 2003 and 2007. The incidences of severe preeclampsia, FGR, placental abruption and stillbirth in the previous pregnancies were similar for both groups. The incidences of severe preeclampsia and placental abruption in the study group in the index pregnancy were significantly lower than the control group (3.13 versus 20%, P = 0.03; and 0 versus 15%, P = 0.03, respectively). The respective incidence of FGR was 6.25 versus 22.5%, and of overall adverse outcome was 9.4 versus 60% (P = 0.001). Treatment with LMWH may reduce the rate of the recurrence of severe pregnancy complications and significant placental vasculopathy in women without thrombophilias.
http://www.ncbi.nlm.nih.gov/pubmed/21192252

I was on lovenox from weeks 7-29. (I went off it because one of the main reasons I was on it was because Olivia was in the less than 1 percentile for growth, severe IUGR. And at 28 weeks our baby was at 76 percentile so growth restriction kinda stopped being a concern. Also, because my MFM doesn't want me on it as we approach delivery time, especially since I don't have a clotting disorder.) In the 2 weeks I've been off it, I've been having some ominous signs that pre-e may be on the way (swelling, some weird blood pressure readings, etc.), so now I'm kind of regretting stopping it so early, though it could be purely coincidence. But I'm really glad we did it.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/

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jean
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Re: Questions about placental abruptions

Postby jean » Sun Oct 07, 639240 7:32 pm

I thought most ppl did better a second time around. This is just depressing!
Our first son was born and passed in Feb of 2010. Born at 29 weeks due to HELLP and passed due to NEC. We miss him every day. :~(

Our second son was born at 39 weeks gestation in Nov of 2011. No HELLP or pre-e! Took LDA starting at week 12 and went off of it at week 38!

http://findingtherainbowconnection.blogspot.com/


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