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Could this have been prevented

Hi, I just have some concern about my pregnancy and hoping someone could help. I am 31 years od age and I have an 10 year old daughter, so when my husband and I found out we were pregnant again we were excited. Everything as going great, even though i was on blood pressure medicine and concerned about my weight, every visit it was normal and the baby and I were fine. I was 12 weeks and after intercourse I started to bleed, not much, but was concerned. went to doctor and after a few test, was told I was fine and the baby was fine, Sometime women bleed during pregnance. I was put on some restriction-no sex for awhile. After that I didn't have any more bleeding. I continued to go to the doctor and contined to pass all test that the dr. was concern about. We were 21 weeks pregnant and  I started bleeding again, this time a little heavier. Went in and took all kinds of test and passed all. they couldn't see anything wrong on ultrasound, found out were having our 1st son, our daughter is so excited, that was on Tuesday. Wednedsay started cramping called doctor he told me too take some tylenol and if bleeding gets worse to come in. The bleeding was still da same I was just cramping.Thursday and Friday feeling great, getting ideas ready for new baby.No cramps just bleeding. SaturdayMorning feeling o.k. later on start cramping badly. realize I was in labor went to hospital at 21 weeks and 4 day delivered our son and 3 hours later he died. I am overwieght 260pds and I am on high blood pressure medicine, they told me that it was an abruptive placenta and happens mostly in wonem with high blood pressure. My question could thia have benn prevented?Why didn't they see this on all the ultrasounds and is bleeding normal in pregancies.
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603463 tn?1220630455
I'm so sorry you lost your beautiful son.  3 hours is far too short a time to be together!
Your story is complicated and your questions are very legitimate.  First of all, bleeding is never normal in pregnancy, and should always be evaluated by a doctor.  There is not much we can do about it, though.  Abruptio placenta is more common in women with hypertension, smokers and women with pre-eclampsia.  SMALL separations of the placenta or small abruptions can be very difficult to see on ultrasound, especially if the mom is a little heavy set.  So it wasn't any one's fault that they couldn't see what was going on when you bled the first few times.  The only way to reduce the risk of abruption is by keeping the blood pressure normal, and not even that works very well.
Once the placenta has separated, there is nothing that can be done.  Pre-term labor can sometimes be stopped if the contractions come before the placenta separates.  But our medications to stop labor are not very good either.  Especially at your very early stage.

If you were my patient, and wanted another child. I would ask you to try to lose some weight, start a good exercise program (like swimming) for your blood pressure, and put you on a daily baby aspirin.  I would also monitor your cervix frequently with ultrasound to see if it was thinning out or dilating.  I would keep you on your blood pressure medication (unless weight loss and exercise worked better!), and DEFINITELY ask that you quit smoking (if you do).

It is so hard to lose a beautiful baby.  I'm sure he was perfect.  I hope you have another one or many more to help you celebrate his memory!
Good luck!
Dr B
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