- What is placental abruption?
- What are the causes and risk factors for placental abruption?
- What are the signs and symptoms of placental abruption?
- How is placental abruption diagnosed?
- Placental abruption: Management and treatment
- What are the complications of placental abruption?
- How to prevent placental abruption?
- Frequently asked questions
About one in 100 pregnancies can have placental abruption, which is one of the significant risks during late pregnancy. It is also a major contributor to maternal and perinatal morbidity and mortality (1).
Knowing more about this pregnancy complication is essential to prevent it, get immediate medical care and reduce the risk for the mother and the baby.
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 before or after conception (preeclampsia)
- Problems associated with the amniotic sac
- Maternal age, pregnancy before 20 or after 35 years
- Short umbilical cord
- Preeclampsia: raised blood pressure
- 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 membranes
- Intrauterine infections
- Carrying more than one baby (twins or multiples)
- Maternal smoking, which is associated with a 90% increased risk (5)
- Cocaine abuse
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 regualr pregnancy checkups, 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.
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
- 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.
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.
- 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 told to take rest at home.
- 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 will do a C section.
- 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
- Failure of kidneys, liver and pituitary gland
- Hysterectomy in the case of uncontrollable uterine bleeding
In the baby, it can lead to:
- Restricted baby growth
- Restricted oxygen supply (leads to brain damage, or even baby’s death)
- Premature baby (before 37 weeks gestation)
- Stillbirth or fetal death
- The newborn may have learning disabilities in the later stages of development
The only way to avoid these complications is to minimize the chances of placental abruption.
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
- 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.
Frequently Asked Questions
1. Can heavy lifting cause placental abruption?
Yes, there is a possibility of placental abruption since lifting heavy objects puts a strong force on the abdomen.
2. Can exercise cause placental abruption?
Exercises with a high risk of falls and abdominal trauma can lead to placental abruption.
3. Can stretching cause placental abruption?
No, stretching will not cause placental abruption unless it is severe enough to put a lot of pressure on the abdomen and uterus. Normal stretching will not cause any harm during pregnancy.
4. What is the risk of placental abruption in the second pregnancy without a prior occurrence?
The risk of placental abruption in the second pregnancy, without abruption in the first pregnancy, is 4.7 and 6.5 for 1000 women with same and different partners respectively (12).
5. Can sex cause placental abruption?
Yes, there is a possibility of placental abruption due to sexual intercourse. This might also lead to intrauterine fetal demise (13). Domestic violence has been identified as a risk.
6. What is the fetal mortality rate due to placental abruption?
The perinatal mortality rate due to placental abruption is as high as 60% (14).
Stay healthy and fit when you are trying to conceive. Go for a complete health checkup before and during pregnancy so that you and your doctor have an idea of your body system.
You can share your thoughts in the comments section below..
2. Y Singh, A Shankar, & S Rohatgi; Abruptio Placentae Leading to Fetal Death and Adult Respiratory Distress Syndrome; Med J Armed Forces India (2008)
3. P. Schmidt; D. A. Raines. Placental Abruption (Abruptio Placentae); StatPearls Publishing LLC (2018)
4. Oyelese Y, Ananth CV; Placental abruption; Obstet Gynecol. (2006)
5. Ananth CV, Smulian JC, Vintzileos AM; Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies; Obstet Gynecol. (1999)
6. Hooria Seyedhosseini Ghaheh et al.; Risk factors of placental abruption; J Res Med Sci (2013)
7. Bleeding in Pregnancy/Placenta Previa/Placental Abruption; The Children’s Hospital of Philadelphia (2018)
8. Placental abruption; Better Health Channel (2018)
9. Ananth C V, Lavery J A; Severe placental abruption: clinical definition and associations with maternal complications; Am J Obstet Gynecol (2016)
10. Placenta abruptio; !!br0ken!! National Library of Medicine (2018)
11. Toshihiko Kinoshita et al.; A Case of Life-threatening Obstetrical Hemorrhage Secondary to Placental Abruption at 17 Weeks of Gestation; Clin Pract (2014)
12. C. V. Ananth; Change in paternity, risk of placental abruption and confounding by birth interval: a population-based prospective cohort study in Norway, 1967–2009; BMJ Journals (2015)
13. Aziken ME; Abruptio placenta following sexual intercourse: case report; Niger Postgrad Med J (2003)
14. Yoshio Matsuda et al.; Prognosis of the Babies Born from Placental Abruption – Difference between Intrauterine Fetal Death and Live-Born Infants; Gynecology & Obstetrics (2013)