Placental Abruption
Placental abruption is a complication of pregnancy that happens when the placenta separates from your uterus before your baby is born. The placenta is a temporary organ that connects a growing baby to your uterus during pregnancy. It attaches to the wall of your uterus, usually on the top or side and acts as a lifeline that gives nutrients and oxygen to your baby through the umbilical cord. The placenta also removes waste from your baby’s blood.
In placental abruption, the placenta may completely detach or partially detach. This can decrease the amount of oxygen and nutrients to your baby and cause heavy bleeding in the mother.
Placental abruption is something that can happen suddenly during pregnancy. It can be dangerous for you and your baby. Fortunately, it’s not common. About 1 out of 100 pregnancies has placental abruption. This condition is usually seen in the third trimester, but it can happen any time after 20 weeks of pregnancy up until delivery.
Types –
• A partial placental abruption occurs when the placenta does not completely detach from the uterine wall.
• A complete or total placental abruption occurs when the placenta completely detaches from the uterine wall. There is usually more vaginal bleeding associated with this type of abruption.
• Revealed placental abruptions have moderate to severe vaginal bleeding that you can see.
• Concealed placental abruptions have little or no visible vaginal bleeding. Blood is trapped between the placenta and uterine wall.
Symptoms –
Placental abruption is most likely to occur in the last trimester of pregnancy, especially in the last few weeks before birth. Signs and symptoms of placental abruption include:
• Vaginal bleeding, although there might not be any
• Abdominal pain
• Back pain
• Uterine tenderness or rigidity
• Uterine contractions, often coming one right after another
• Problems with the baby’s heart rate
Abdominal pain and back pain often begin suddenly. The amount of vaginal bleeding can vary greatly, and doesn’t necessarily indicate how much of the placenta has separated from the uterus. It’s possible for the blood to become trapped inside the uterus, so even with a severe placental abruption, there might be no visible bleeding.
In some cases, placental abruption develops slowly (chronic abruption), which can cause light, intermittent vaginal bleeding. Your baby might not grow as quickly as expected, and you might have low amniotic fluid or other complications.
Causes –
The cause of placental abruption is often unknown. Certain lifestyle choices or abdominal trauma can increase your risk for placental abruption.
Possible causes include trauma or injury to the abdomen — from an auto accident or fall, for example — or rapid loss of the fluid that surrounds and cushions the baby in the uterus (amniotic fluid).
Risk Factors –
Factors that can increase the risk of placental abruption include:
• Placental abruption in a previous pregnancy that wasn’t caused by abdominal trauma
• A fall or other type of blow to the abdomen
• Chronic high blood pressure (hypertension)
• Hypertension-related problems during pregnancy, including preeclampsia, HELLP syndrome or eclampsia
• Early rupture of membranes, which causes leaking amniotic fluid before the end of pregnancy
• Infection inside of the uterus during pregnancy (chorioamnionitis)
• Being older, especially older than 40
• Smoking
• Cocaine use during pregnancy
Complications –
It can be life-threatening to your baby and sometimes to you. Complications from a placental abruption include:
For baby:
• Premature birth.
• Low birth weight.
• Growth problems.
• Brain injury from lack of oxygen.
• Stillbirth.
For mother:
• Blood loss.
• Blood clotting issues.
• Blood transfusion.
• Hemorrhage.
• Kidney failure
Diagnosis –
If you’re having bleeding or abdominal pain, you’ll need to see your doctor right away. They’ll do a physical exam and run blood tests, and also may perform an ultrasound to see inside your uterus. (Ultrasounds don’t always show placental abruptions).
Treatment –
The treatment for this complication of pregnancy depends upon the severity of the abruption. Your doctor will determine if your placental abruption is mild, moderate, or severe. Mild placental abruption is when blood loss has occurred, but the bleeding has slowed and you and your baby are stable.
Treatments will also depend on how far along you are in your pregnancy. If you’ve lost a significant amount of blood, you may need a blood transfusion.
• Mild placental abruption at 24 to 34 weeks. If you and your baby are doing well, your doctor may give you medications to try and speed up your baby’s lung development and allow them to keep developing. If your bleeding seems to have stopped or slowed, your doctor may send you home. Otherwise, you may need to remain in the hospital for close monitoring.
• Mild placental abruption at 34 weeks or greater. If you’re near full-term, your doctor may induce labor or perform a cesarean delivery. If your baby has had time to develop, an earlier delivery can reduce the risks for further complications.
• Moderate to severe placental abruption. This degree is — marked by significant blood loss and complications to you and your baby — usually requires immediate delivery, often by cesarean.
In rare instances, if your doctor can’t stop your bleeding, you may need a hysterectomy. This is the surgical removal of the uterus. Again, this is in rare instances of severe bleeding.
Prevention –
You can’t prevent placental abruption, but you can decrease certain risk factors. For example, don’t smoke or use illegal drugs, such as cocaine. If you have high blood pressure, work with your health care provider to monitor the condition.
Always wear your seatbelt when in a motor vehicle. If you’ve had abdominal trauma — from an auto accident, fall or other injury — seek immediate medical help.
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