Placental abruption

Definition

Placental abruption is an uncommon and serious complication of pregnancy.

The placenta is a structure that develops in the uterus during pregnancy to nourish the growing baby. If the placenta peels away from the inner wall of the uterus before delivery — either partially or completely — it's known as placental abruption (abruptio placentae). Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother.

Left untreated, placental abruption puts both mother and baby in jeopardy. Placental abruption is an emergency, requiring immediate medical attention.

Placental abruption

Placental abruption

Placental abruption occurs when the placenta peels away from the inner wall of the uterus before birth. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in ...

Symptoms

Placental abruption can begin anytime after 20 weeks of pregnancy. Classic signs and symptoms of placental abruption include:

• Vaginal bleeding
• Abdominal pain
• Back pain
• Uterine tenderness
• Rapid uterine contractions, often coming one right after another

Abdominal pain and back pain often begin suddenly. The amount of vaginal bleeding can vary greatly, and doesn't necessarily correspond to how much of the placenta has separated from the inner wall of the uterus. It's even possible to have a severe placental abruption and no visible bleeding.

When to see a doctor
Seek emergency care if you experience any signs or symptoms of placental abruption, including:

• Vaginal bleeding
• Abdominal pain
• Severe back pain
• Rapid uterine contractions

Causes

The specific cause of placental abruption is often unknown.

Possible causes of placental abruption include:

• Trauma or injury to the abdomen — from an auto accident or fall, for example
• An unusually short umbilical cord
• Rapid loss of the fluid that surrounds and protects the baby in the uterus (amniotic fluid)

Placental abruption

Placental abruption

Placental abruption occurs when the placenta peels away from the inner wall of the uterus before birth. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in ...

Risk factors

Various factors may increase your risk of placental abruption, including:

• Previous placental abruption. If you've experienced placental abruption before, your risk of experiencing it again is significantly higher.
• High blood pressure. High blood pressure — whether chronic or a result of pregnancy — increases your risk of placental abruption.
• Abdominal trauma. Trauma to your abdomen, such as from a fall or other type of blow to the abdomen, increases your risk of placental abruption.
• Substance abuse. Placental abruption is more common in women who smoke or use cocaine during pregnancy.
• Preterm premature rupture of the membranes. During pregnancy, the baby is enclosed in a sac filled with amniotic fluid, and the outer portion of this sac is referred to as amniotic membranes. If the membranes rupture early or if they develop a hole, your risk of placental abruption rises.
• Blood-clotting disorders. Any condition that impairs your blood's ability to clot increases your risk of placental abruption.
• Multiple pregnancy. Carrying twins, triplets or other multiples increases your risk of placental abruption.
• Previous pregnancies. The more times you've been pregnant, the higher your risk of placental abruption.
• Age. Placental abruption is more common in women age 35 and older.

Complications

Placental abruption can cause life-threatening problems for both mother and baby. Without prompt treatment, placental abruption may lead to:

• Maternal shock
• Premature birth
• The fetus being deprived of oxygen and nutrients
• Later neurological problems in the baby
• Stillbirth

Blood loss may be a concern after delivery, too. If bleeding from the site of the placental attachment can't be controlled after the baby is born, emergency removal of the uterus (hysterectomy) may be needed.

Preparing for your appointment

A placental abruption is often a medical emergency, leaving you no time to prepare. However, it's possible that your pregnancy health care provider may notice signs of an impending abruption before an emergency situation develops.

Depending on the suspected severity of your placental abruption, you may be admitted to the hospital and monitored. Or you may be admitted for emergency surgery to deliver the baby.

If you and the baby are being monitored in the hospital, here's some information to help you get ready for what's to come, and what to expect from your doctor.

What you can do

• Keep track of any symptoms you're experiencing, and let a doctor or nurse know immediately if there are any changes.
• Make a list of all medications, vitamins and supplements that you've been taking. And be sure to let your doctor know if you've smoked during your pregnancy or used illegal drugs.
• Ask a family member or friend to be with you, if possible. Sometimes it can be difficult to remember all of the information provided, especially in an emergency situation. Someone who's with you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

A placental abruption can develop without warning, and this situation has likely left you with numerous questions. Preparing a list of those questions can help you make sure you cover the points that are important to you when you speak with your doctor. Some basic questions you might want to ask your doctor include:

• Why is this happening?
• Did I do something wrong during my pregnancy?
• What kinds of tests do I need? Do I need to prepare for these tests?
• Is the baby in any danger? Am I in any danger?
• Is surgery the only treatment available?
• What are the possible complications?
• If the baby needs to be delivered, what can I expect regarding nursery care?
• Are there any problems with my blood's clotting factors?
• Will I need a blood transfusion?
• What are the chances that I might have to have a hysterectomy after the delivery?
• Are there any activity restrictions that I need to follow?
• How can I prevent this from happening in future pregnancies?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions anytime that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• When did you first begin experiencing symptoms?
• Have you noticed any changes in your symptoms?
• How much bleeding have you seen?
• Can you feel your baby moving?
• Have you noticed any clear fluid leaking from your vagina?
• Have you had any nausea, vomiting or lightheadedness?
• Are you having contractions? If so, how close together are they

Tests and diagnosis

If your health care provider suspects placental abruption, he or she will check for uterine tenderness or rigidity.

To help identify possible sources of vaginal bleeding, you may need:

• Blood tests
• An ultrasound

During an ultrasound, high-frequency sound waves are used to create an image of your uterus on a monitor. Often, however, it's not always possible to see a placental abruption on an ultrasound. And, some placental abruptions can't be confirmed until after delivery — when the placenta is delivered with an attached blood clot.

Treatments and drugs

Treatment for placental abruption depends on the circumstances:

• Babies not close to full term. If the abruption seems mild, your baby's heart rate is normal and it's too soon for the baby to be born, you may be hospitalized for close monitoring. If the bleeding stops and your baby's condition is stable, your health care provider may prescribe rest at home. In some cases, you may be given medication to help your baby's lungs mature — in case early delivery becomes necessary.
• Babies close to full term. If your baby is almost full term and the placental abruption seems minimal, a closely monitored vaginal delivery may be possible. If the abruption progresses or jeopardizes your health or your baby's health, you'll need an immediate delivery — usually by C-section. If you experience severe bleeding, you may need a blood transfusion.

There's no way to reattach a placenta that's separated from the wall of the uterus.

Prevention

You can't prevent placental abruption, but you can decrease certain risk factors that make a placental abruption more likely.

To reduce your risk of placental abruption:

• Don't smoke
• Don't use illegal drugs, such as cocaine
• Control high blood pressure and other chronic conditions
• Use a seat belt whenever you're in a car to minimize potential trauma

If you've had a placental abruption, talk to your health care provider about ways you can reduce your risk before conceiving again. And, when you become pregnant, your health care provider will carefully monitor your condition.