Placental Abruption

Pregnant Mother in DistressPlacental abruption (also called "placenta abruptio") is an uncommon and potentially dangerous complication during pregnancy in which the placenta prematurely detaches from the uterus before birth.

The placenta is an organ that plays a critical role in pregnancy and gestation. The placenta is responsible for delivering nutrients from the mother to the baby during pregnancy. In a normal pregnancy, the placenta attaches to the upper part of the uterus and stays attached until the baby is actually delivered. The separation of the placenta from its site of implantation before the delivery of the fetus is called placental abruption So placental abruption occurs when the placenta detaches and separates from the uterus prematurely, before the baby is born. Placental abruption typically occurs around the 25th week of pregnancy but it is not a particuarly common complication. Placental abruption only affects between 1% and 6% of all pregnancies.

Placental abruption may be occult and not associated with uterine pain, tenderness, and bleeding. Placental abruption can occur with little or no external signs of injury to the abdominal wall.

Symptoms of Placental Abruption

In the earliest stages of placental abruption (when the placenta first begins to detach from the uterus) there may not be any noticeable symptoms at all. When symptoms appear later on they tend to show up very suddenly and be very intense. Sudden vaginal bleeding is the primary symptom of placental abruption. Around 80% of women who experience placental abruption will have vaginal bleeding. The remaining 20% of placental abruption cases do not result in vaginal bleeding, usually because the detached placenta is positioned in a way the effectively traps the blood. The other key symptoms of placental abruption include:

  • Sudden and often severe pain in the abdomen or back
  • Abdominal tenderness
  • General discomfort
Causes and Risk Factors of Placental Abruption

In some cases placental abruption is caused by bleeding resulting from some sort of abdominal trauma to the mother. Car accidents are a common cause of this type external trauma to a pregnant woman's abdomen. In most other cases, however, the exact cause of the placental abruption is not fully known. There are a number of well-known risk factors that have been shown to increase a woman's likelihood of experiencing a placental abruption. The most common recognized risk factors for placental abruption are:

  • Maternal Age: older mothers are much more likely to experience placental abruption compared to younger mothers, so maternal age over 35 increases the risk of placental abruption.
  • Multiples: a pregnancy with multiples (e.g., twins, triplets, etc.) makes abruption more likely, especially for the 2nd baby because the placenta frequently detaches after the first baby is delivered.
  • High Blood Pressure: a maternal history of hypertension (high blood pressure)
  • History of Abruption: mothers who had a placental abruption in a prior pregnancy are 10 times more likely to have one again in a subsequent pregnancy.
  • Smoking: a recent study found that women who were regular cigarette smokers before getting pregnant, increased their chance of placental abruption by 40% for each year that they smoked.
  • Cocaine: cocaine use during the 3rd trimester of pregnancy increases the chance of placental abruption from 1% to 10%.
Diagnosis of Placental Abruption

Placental abruption cannot be diagnosed definitively until after the baby is delivered. However, doctors will often suspect placental abruption and may have evidence to support that suspected diagnosis. Diagnostic testing for placental abruption usually starts with a physical examination of the mother followed by an ultrasound or sonogram imaging test. Blood work and fetal monitoring devices might also be used to gather information and decide on the most appropriate course of action.

Treatment Options for Placental Abruption

The appropriate method for treating or managing placental abruption will depend on the timing and severity of the placental abruption.

Mild Placental Abruption

Just under half (48%) of placental abruptions are classified as "mild" in severity. Placental abruptions are considered mild when they involve limited vaginal bleeding; maternal heart rate and blood pressure remain stable; and there are no indications of fetal duress. For mild placental abruptions that occur before the 34th week of gestation, doctors will usually try to prolong the pregnancy as long as possible. Management will typically involve medication to prolong gestation and very close monitoring. Best rest or possibly hospital care is also standard. When a mild placental abruption occurs closer to the end of the pregnancy (after the 34th week), doctors will usually recommend delivering the baby right away. This will involve either an emergency C-section or inducing labor.

Moderate or Severe Placental Abruption

Placental abruptions are considered moderate or severe when vaginal bleeding is heavy or moderate and the abruption triggers maternal tachycardia or elevated blood pressure. When the placental abruption is moderate or severe, immediate delivery of the baby is typically required regardless of how far along the pregnancy is. If the bleeding from the placental abruption is particularly heavy, a blood transfusion may be necessary. Although rare, some placental abruptions trigger uncontrolled bleeding which can only be stopped by performing an emergency hysterectomy (surgical removal of the uterus).