re>>>>>>>This is Cindy Luxford's apprentice Katherine<<<

hi

re>>>>. We have a mom who has had a partial abruption at 27 weeks. The doctor has told her she has a 33% of it getting worse, 33% chance of it getting better, and 33% chance of staying the same.<<<<<<<

that's pretty funny!

the 33% number is just a way of saying "I don't know what will happen".
is she still bleeding?

re<<< The OARs state placental abruption as an absolute risk in both the antepartum and intrapartum categories. <<<<<<<<<

are you sure about antepartum?
because i don't see there is risk if a woman has a partial abruption which heals before term. my understanding of the rules is the refer to an active abruption, not a past or "threatened" abruption. obviously if she has an active abruption, she is going to the hospital! but a "history" is a different situation.

RE>>>>>> What if the abruption heals and she carries her baby to term? <<<<<<<<<<

i have seen this happen a number of times.

i would agree with the doc that it can be hard to predict, but that most women will either abrupt completly within a few days of having an "threatened abruption" or else it will heal over and they will not have any more symptoms. It's rare for the symptoms to continue unchanged.

re>>>>>And regardless of location of birth, are you aware of any research on potential risks of term vaginal delivery after a 2nd trimester placental abruption?<<<<<<<<<<

i don't know of any research but I have personally had a couple of women who did this - and i know of midwives who have had others. We do not consider a history of a "threatened" problem to be the same as the actual and current problem.

if the placenta remains attached and the pregnancey continues to term, i really can't see any likely risk.

it'd be wisest to do a couple of ultrasound scans in the next few weeks, just to double-check, but if the bleeding is stopped and the placenta site looks good and hte baby is growing well, then this is proof the placenta is working just fine.

re>>>The mom has loads of questions as you can imagine, and I'm just trying to gather as much information as possible.>>>

you should have some texts which discuss managament of threatened or partial abruption under a heading such as "bleeding in pregnancy" or "antepartum hemmorage"

i assume there was a scan done. Was the placenta normally sited -- not low - in the uterus? If there is no sign of previa, then odds are better for mom.

was the site of bleeding located? If so, was it subchorionic or retro-placental? if it was retroplacental (behind the placenta) then these tend to get worse. If it was subchorionic (between the placenta and membranes -- it is more likely to heal.

is a clot visible? Is it growing -- or is it resolving?

is the mother still bleeding?

sometimes a woman has a 'sinus bleed" or "marginal bleed" and these tend to do well also because there is no clot under the placenta (a growing clot can force the placenta to pull away from the uterine wall.

ONly time will tell what will happen in this case.
i've seen women stop bleeding and go on to have a normal term birth.
i've also seen a few who continued to bleed and/or who started labor. Blood is a uterine irritant.

good luck! Let us know how everything turns out..
gail

Email: hdw4@msn.com