Placental Abruption

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 is known to occur any time after the 20th week pregnant, and occurs in 1% 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, a guaranteed interruption of oxygen and nutrients is inevitable and life-threatening to an unborn baby. Unfortunately, diagnosis of placental abruption can not be determined until after birth, when doctors have a chance to examine the placenta. Methods to diagnose the condition include:

  • An ultrasound
  • Evaluation of patient’s symptoms
  • Fetal monitoring
  • Blood tests

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. Grades are given as followed:

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 of mother or 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 various different signs and symptoms that placental abruption has occurred. These symptoms include:

  • Tenderness in the uterus
  • Vaginal bleeding
  • Rapid contractions
  • Abdominal pain
  • Fetal heart rate abnormalities

Vaginal bleeding can be considered rare, as it only happens to 1 in5 of the 1% of women who develop a placental abruption. If vaginal bleeding occurs in the third trimester, help should be sought after immediately, as vaginal bleeding can also be a symptom of placenta previa.

Causes of Placental Abruption

There are not many known causes of placental abruption, however, many women who suffer from the condition have the following characteristics in common:

  • Smokers
  • Over the age of 35
  • Cocaine usage 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, location of the separation, and the age of the pregnancy. The separation can be classified as partial or complete. Plus, there can also be different degrees of each of these, which impacts the type of treatment a doctor will forego. 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% of cases where 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 used too. If complete separation has occurred, delivery is usually the safest option, even if the pregnancy is not full term. Depending on whether or not the fetus is stable, determines if he or she is born via vaginally or 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
  • Diabetes

Preventing Placental Abruption

The best way to prevent placental abruption is to avoid any alcohol, drugs, and smoking. 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 this, and many other conditions women face while pregnant.

If a woman is in a car accident, even minor, she should consult a doctor. If she is at risk for, or has already been diagnosed with conditions such as diabetes or high blood pressure, she should let her health care provider know during those initial prenatal visits. This condition can develop and worsen rapidly, so it’s important that if an expectant mother suspects placental abruption she should seek immediate help to prevent life-threatening situations.

[Page updated November 2013]