Placental Abruption (Abruptio Placentae)
When the placenta separates from the uterine lining it’s known as placental abruption. Usually occurring in the third trimester, this condition can occur any time after the 20th week of pregnancy, and occurs in 1 percent of all pregnancies. The placenta is what provides oxygen and nutrients to your baby before birth. If the placenta separates from the uterine lining before labor, an interruption of oxygen and nutrients is inevitable, and it is life-threatening to an unborn baby. Unfortunately, placental abruption cannot be diagnosed until after birth, when doctors have a chance to examine the placenta.
Placental abruptions are classified on a graded scale of 0–3, according to the severity of the detachment, bleeding, and distress of mother and fetus. The grades are assigned as follows:
Grade 0: Asymptomatic and only diagnosed through post-partum examination of the placenta.
Grade 1: Mom may have vaginal bleeding and mild uterine tenderness, with no distress experienced by either the mother or the fetus.
Grade 2: Mother is symptomatic but has not gone into shock; fetal heart-rate monitoring is performed to detect fetal distress.
Grade 3: Severe bleeding occurs, which leads to maternal shock and fetal death.
Placental Abruption Symptoms
There are several signs that placental abruption has occurred. These symptoms include:
- Tenderness in the uterus
- Vaginal bleeding
- Rapid contractions
- Abdominal pain
- Fetal heart rate abnormalities
Vaginal bleeding is rare — it only happens to one in five of the 1 percent of women who develop a placental abruption. If vaginal bleeding occurs in the third trimester, help should be sought immediately, as vaginal bleeding can also be a symptom of placenta previa.
Causes of Placental Abruption
The causes of placental abruption are unknown, but many women who suffer from the condition have the following in common:
- Over the age of 35
- Cocaine use during pregnancy
- Previous placental abruptions
- Trauma to the abdomen
- Abnormalities in the uterus
- Carrying multiples
- Have preeclampsia or hypertension
Placental Abruption Treatment
There are three things doctors consider before treating placental abruption: the severity of the separation, the location of the separation, and the age of the pregnancy. The separation can be classified as partial or complete. There can also be different degrees of each of these, which influences the doctor’s choice of treatment. The bottom line is that there is no treatment that can stop the placenta from detaching, nor is there a way to reattach it. Approximately 15 percent of cases in which severe placental abruption occurs, ends in the death of the fetus.
If partial separation has occurred, doctors will more than likely recommend bed rest and close monitoring until the pregnancy reaches maturity. Occasionally, transfusions and other emergency treatment methods are also used. If complete separation has occurred, delivery is usually the safest option, even if the pregnancy is not full term. The stability of the fetus determines whether it is born via vaginally or via c-section.
Placental Abruption Risks Factors
There are a few things that can increase the risk of placental abruption, such as:
- Maternal hypertension
- Maternal trauma
- Short umbilical cord
- Prolonged rupture of membranes
- Maternal age
- Certain infections
- Retroplacental fibromyoma
- Cigarette smoking
- Cocaine usage
- Previous placental abruptions
- Alcohol abuse
- High blood pressure during pregnancy
- Large number of prior deliveries
Preventing Placental Abruption
The best way to prevent placental abruption is to avoid alcohol, drugs, and smoking while pregnant. These three things are known to cause placental abruption. Early and continuous prenatal care can help detect the condition early on, and therefore treatment, monitoring, and management of the condition can last until the pregnancy has reached full term. Experts say that exercise and a well balanced diet also help prevent placental abruption.
If a woman is in even a minor car accident, she should consult a doctor. If she is at risk for conditions such as diabetes or high blood pressure, she should let her healthcare provider know during the initial prenatal visits. This condition can develop and worsen rapidly, so it’s important for an expectant mother to seek immediate help to prevent life-threatening situations if she suspects placental abruption.