Secondary prevention
There is a large crossover between the lifestyle and activity recommendations to prevent a myocardial infarction, and those that may be adopted as secondary prevention after an initial myocardial infarct. Recommendations include stopping smoking, a gradual return to exercise, eating a healthy diet, low in saturated fat and low in cholesterol, drinking alcohol within recommended limits, exercising, and trying to achieve a healthy weight. Exercise is both safe and effective even if people have had stents or heart failure, and is recommended to start gradually after 1–2 weeks. Counselling should be provided relating to medications used, and for warning signs of depression. Previous studies suggested a benefit from omega-3 fatty acid supplementation but this has not been confirmed. Medications
Following a heart attack, nitrates, when taken for two days, and ACE-inhibitors decrease the risk of death. Other medications include:
Aspirin is continued indefinitely, as well as another antiplatelet agent such as clopidogrel or ticagrelor ("dual antiplatelet therapy" or DAPT) for up to twelve months. If someone has another medical condition that requires anticoagulation (e.g. with warfarin) this may need to be adjusted based on risk of further cardiac events as well as bleeding risk. In those who have had a stent, more than 12 months of clopidogrel plus aspirin does not affect the risk of death.Beta blocker therapy such as metoprolol or carvedilol is recommended to be started within 24 hours, provided there is no acute heart failure or heart block. The dose should be increased to the highest tolerated.
The fetal prognosis is worse than the maternal prognosis; approximately 12% of fetuses affected by placental abruption die. 77% of fetuses that die from placental abruption die before birth; the remainder die due to complications of preterm birth.Without any form of medical intervention, as often happens in many parts of the world, placental abruption has a high maternal mortality rate. Mother
A large loss of blood may require a blood transfusion. If the mothers blood loss cannot be controlled, an emergency hysterectomy may become necessary. The uterus may not contract properly after delivery so the mother may need medication to help her uterus contract. The mother may develop a blood clotting disorder, disseminated intravascular coagulation. A severe case of shock may affect other organs, such as the liver, kidney, and pituitary gland. Diffuse cortical necrosis in the kidney is a serious and often fatal complication. Placental abruption may cause bleeding through the uterine muscle and into the mothers abdominal cavity, a condition called Couvelaire uterus. Maternal death. Baby
The baby may be born at a low birthweight. Preterm delivery (prior to 37 weeks gestation). The baby may be deprived of oxygen and thus develop asphyxia. Placental abruption may also result in death of the baby, or stillbirth. The newborn infant may have learning issues at later development stages, often requiring professional pedagogical aid. Epidemiology
Placental abruption occurs in approximately 0.2–1% of all pregnancies.