Placental abruption

Placental abruption (abruptio placenta) is an uncommon, but serious complication of pregnancy that requires immediate medical attention.

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. 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

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 and back pain often begins suddenly. The amount of vaginal bleeding can vary greatly. The amount of blood doesn't necessarily correspond to how much of the placenta has separated from the inner wall of the uterus. If you experience any signs or symptoms of placental abruption, seek emergency care.

Causes

The specific cause of placental abruption is often unknown. In some cases, trauma or injury to the abdomen from a car accident or fall causes placental abruption. Rarely, placental abruption is caused by an unusually short umbilical cord or rapid loss of the fluid that surrounds and protects the baby in the uterus (amniotic fluid).

Risk factors

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

Previous pregnancies. The more times you've been pregnant, the higher your risk of placental abruption.
Previous placental abruption. If you've experienced placental abruption before, the risk of experiencing it again may be 15 percent or even higher. The risk of premature birth and pre eclampsia also is higher.
High blood pressure. High blood pressure increases the risk of placental abruption, whether you have chronic high blood pressure or the high blood pressure first developed during pregnancy.
Blood-clotting disorders. Any condition that impairs your blood's ability to clot increases the risk of placental abruption.
Multiple pregnancies. Carrying twins, triplets or other multiples increases the risk of placental abruption.
Excess amniotic fluid. The risk of placental abruption is higher if you have an unusually large amount of amniotic fluid.
Age. Placental abruption is more common in women aged 40 and older.
Abdominal trauma. Trauma to the abdomen such as from a fall or other type of blow to the abdomen increases the risk of placental abruption.
Substance abuse. Placental abruption is more common in women who smoke, drink alcohol, or use cocaine or methamphetamine during pregnancy.

When to seek medical advice

Seek emergency care if you experience any signs or symptoms of placental abruption, including:

Vaginal bleeding
Abdominal pain
Back pain
Rapid uterine contractions

Complications

Placental abruption can cause life-threatening problems for both mother and baby. Without prompt treatment, maternal blood loss may lead to shock. Your baby may be born prematurely and deprived of oxygen and nutrients. Sometimes, decreased oxygen to the brain leads to later neurological or behavioural problems. 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.

Treatment

Treatment for placental abruption depends on the circumstances. 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 hospitalised for close monitoring. If the bleeding stops and your baby's condition is stable, your doctor 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.

If you're 36 weeks or more into your pregnancy and placental abruption is minimal, a closely monitored vaginal delivery may be possible. If the abruption progresses or jeopardises 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. Don't smoke, drink alcohol or use illicit drugs during pregnancy. If you have high blood pressure or diabetes, work with your doctor to control your condition. If you've had a placental abruption, talk to your doctor before conceiving again.

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