Placental Abruption: Symptoms, Causes, Diagnosis & Treatment

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Placental abruption is a rare pregnancy complication that may adversely affect the mother and baby. Data shows that around one in 100 pregnant women experiences placental abruption, an important factor contributing to perinatal and maternal morbidity globally (1).

Understanding what placental abruption is and what causes it is vital for pregnant women to get immediate medical help and avert its complications.

Continue reading to learn more about placental abruption, including its causes, risk factors, signs and symptoms, diagnosis, treatment, management, and prevention. This post also discusses some frequently asked questions about placental abruption, such as whether it can be caused by exercise.

What Is Placental Abruption?

Placental abruption, premature separation of placenta or detached placenta, is a rare but serious complication of pregnancy. It is the separation of the placenta from the uterus before the birth of the baby.

This condition occurs after the 20th week of pregnancy, commonly in the third trimester, suddenly during labor, and deprives the baby of oxygen and nutrients and can initiate severe bleeding in the mother and a possibility of kidney failure and a threat to life(2).

Severe abruption of the placenta is life-threatening to the mother and the baby (3).

Based on the separation and location of the placenta, placental abruption is of three types – complete, marginal, and central (3).

• Complete placental abruption: The placenta is completely separated from the lining of the uterus, causing heavy vaginal bleeding.

• Marginal (partial) placental abruption: The placenta is separated only at the edges, resulting in some vaginal bleeding

• Concealed (central or silent) placental abruption: The blood is trapped between the placenta and the uterine wall with no vaginal bleeding.

What Are The Causes And Risk Factors For Placental Abruption?

The cause of placental abruption is usually unknown. However, one probable causative factor is the irregular supply of blood in the placenta or uterus which can be a result of inadequate placental formation which happens in the very early part of pregnancy at implantation but manifests later. Other factors that could pose a risk of placental abruption are (4).

• History of placental abruption in previous pregnancies; there is a 10% chance of placental abruption in a subsequent pregnancy

• High blood pressure (hypertension) before or after conception (preeclampsia)

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• Problems associated with the amniotic sacⁱXThe thin-walled fluid-filled sac in the uterus where the embryo grows and eventually forms the fetus.

• Maternal age, pregnancy before 20 or after 35 years

• Short umbilical cord

• Preeclampsia: raised blood pressure

• Gestational Diabetes

• Thrombophilia (abnormal development of blood clots)

• Delivery through c-section in an earlier pregnancy

• Abdominal trauma caused by accidents, falls or infections

• Preterm rupture of membranesⁱXA pregnancy complication where the amniotic sac's membranes break before labor starts, leading to amniotic fluid leakage.

• Intrauterine infectionsⁱXA condition where the vaginal bacteria infect the umbilical cord, amniotic fluid, or membranes enclosing the fetus.

• Multiple gestation (carrying more than one baby)

• Placenta previa

• Carrying more than one baby (twins or multiples)

• Maternal smoking, which is associated with a 90% increased risk (5)

• Maternal cocaine use

Though you cannot prevent all of these risk factors, there are some things you can avoid, such as alcohol and tobacco and take proper nutrition and regular pregnancy check ups, to lessen your odds.

Being prepared for it and knowing how to identify it can help minimize the risks to the mom and the baby.

Quick fact

Large or multiple uterine fibroidsⁱXBenign growth of muscle and connective tissues in the walls of the uterus. are associated with placental abruption (15).

What Are The Signs And Symptoms Of Placental Abruption?

The signs and symptoms vary from moderate to severe. Watch out for (6):

• Vaginal bleeding

• Pain in the abdomen when touched or otherwise

• Lower back pain

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• Tender and hard uterus (womb)

• Frequent uterine contractions

• Fetal distress, such as abnormal heart rhythm

Back pain or discomfort, and sometimes spotting, which are quite common during pregnancy, are the usual symptoms of placental abruption. However, they cannot be regarded as signs of placental abruption alone. These symptoms will worsen with time in the case of abruption and need immediate medical intervention.

Point to consider

Some other signs of placental abruption include amniotic fluid with blood and feeling dizzy and nauseous (7).

How Is Placental Abruption Diagnosed?

The condition is diagnosed based on the symptoms, vaginal bleeding, pain, and discomfort. Your healthcare provider will conduct a few tests to confirm the cause and give the right treatment (7).

• Physical exam: The doctor will perform a physical exam to check the state of your uterus. Any rigidness or tenderness in the uterus indicates a problem that needs medical attention.

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• Blood tests: Your doctor may conduct a complete blood count (CBC) to know your platelet count. A low platelet count increases the risk of blood loss. A blood test can also confirm if you have anemia. Anemia can indicate heavy blood loss due to placental abruption.

• Fetal heart rate monitoring: It confirms the state of the baby’s health by measuring the fetal heart rate and rhythm. Abnormal heartbeat could be an indication of placental abruption

• Vaginal ultrasound: It helps your doctor detect vaginal bleeding and placental separation.

In some cases, the condition cannot be diagnosed until delivery. The delivered placenta shows attached blood clots which appear old. The placenta is then sent to the laboratory for further testing.

Placental Abruption: Management and Treatment

Regardless of the condition’s severity, the doctor will monitor you and the fetus closely, depending on how far along you are in pregnancy (8).

• Mild condition and early pregnancy: If the vaginal bleeding stops and your baby is not distressed, you are told to take rest at home.

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• Moderate condition and early pregnancy: Your doctor may want you to remain in the hospital until the delivery. Medications are prescribed for maturation of the baby’s lungs.

• Mild to moderate conditions and late pregnancy: Your doctor will recommend delivery and tries for a vaginal birth. If the placenta separates further from the uterine wall, the doctor may suggest a cesarean delivery.

• Severe condition: You may have to go for immediate delivery, followed by supportive care. Heavy bleeding can be either treated by blood transfusion or hysterectomy (surgical removal of the uterus done here as a life-saving procedure). In the case of hysterectomy, you will not be able to get pregnant again.

What Are The Complications Of Placental Abruption?

There won’t be any complications in the case of partial placental abruption, where only a small part of the placenta separates (retroplacental clot). But if all of it or a significant part of the placenta separates, it can lead to complications (9).

In the mother, it can lead to:

• Blood loss, causing shock

• Blood clotting problems

• Maternal death from blood loss

• Need for blood transfusion

A mother of two shares her story of having had a placental abruption during the birth of her baby girl. She says, “I suffered a placental abruption just as we were getting ready for bed Sunday night. I had a difficult time in surgery because, besides having a placental abruption, they discovered I had a rare condition called placenta accreta. I apparently lost so much blood I didn’t have protein/plasma in my blood to stop bleeding, and I was hemorrhaging. After having had three blood transfusions and two plasma transfusions, our wonderful and talented doctor was able to save me (i).”

• Failure of kidneys, liver and pituitary gland

• Preterm labor

• Uterine rupture

• Hysterectomy in the case of uncontrollable uterine bleeding

In the baby, it can lead to:

• Low birth weight due to restricted baby growth

• Restricted oxygen supply (leads to brain damage, or even baby’s death)

• Premature birth (before 37 weeks gestation)

• Miscarriage or stillbirth

• Stillbirth or fetal death

• The newborn may have learning disabilities in the later stages of development

Paul Isaacs, a prematurely born boy, shares his story of how placental abruption led him to have a series of problems in later stages. He says, “My mother and I were both in distress during her pregnancy – I was born premature and was born via a cesarean section, and my mother suffered heavy bleeding as a result of what is called placental abruption (ii).

In another blog, Isaac adds, “Brain damage and/or brain injury is a part of the reason why I have autism. The placental abruption and oxygen deprivation that happened, caused the stroke, left-right disorientation, visual perceptual disorders, language processing disorder (aphasia), and issues with internalizing and externalizing language and other developmental aspects (iii).”

According to the National Institutes of Health (NIH), placental abruption accounts for about one to five percent of maternal fatalities annually in the US. The likelihood of fetal mortality, on the other hand, varies from 1% to 40% depending on factors such as fetal age and the extent of detachment.

The only way to avoid these complications is to minimize the chances of placental abruption.

Did you know?

Placental abruptions occur more frequently among women with evidence of oxidative stress and iron deficiency anemia during pregnancy (1).

How To Prevent Placental Abruption?

There is no surefire way to prevent placental abruption. But you can take some measures to reduce your risk of the complication (10).

• Avoid smoking, alcohol and drug abuse

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• Avoid medications unless prescribed by your doctor

• Keep your blood pressure levels in check, seek doctor’s help regularly

• Avoid the risk of trauma. Walk carefully, and wear a seatbelt while traveling in a car

• Let your doctor know if you had placental abruption in the earlier pregnancy

• Maintain a good diet and include prenatal supplements as prescribed by your doctor

• Maintain a sleep schedule

Next, we address a few frequent queries from our readers.

Infographic: How To Reduce The Risk Of Placental Abruption?

Placental abruption is a rare pregnancy-related complication that can cause maternal and fetal mortality risk. In addition, it can lead to severe consequences, such as preterm birth and fetal distress. The following infographic outlines some tips to help lower the risk of developing this condition.

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Learn about placental abruption and its causes, symptoms, diagnosis, treatment, and pathology. Understand how to recognize the signs and when to seek medical care.

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Dr. Girija WaghMD

Dr. Girija Wagh has nearly 30 years of experience in high-risk obstetrics and her extensive practice focuses on all gynecological procedures including, fertilization, impregnation and childbirth complications.  Dr. Wagh is currently runs her private practice Girija Hospital  in Kothrud, Pune. She also provides consultation services at Apollo Hospital, Cloudnine, and Bharati Hospitals, Katraj, Pune.more

Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU). She has been into health and...more

Swati PatwalM.Sc. (Food & Nutrition), MBA

Swati Patwal is a clinical nutritionist, a Certified Diabetes Educator (CDE) and a toddler mom with more than a decade of experience in diverse fields of nutrition. She started her career as a CSR project coordinator for a healthy eating and active lifestyle project catering to school children. Then she worked as a nutrition faculty and clinical nutrition coach in...more

Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction. She writes health and wellness articles for children and pregnant and lactating women. Reshmi has completed her post graduation in Biotechnology from MITS School of Biotechnology,...more