Placental Abruption

What is placental abruption?

Placenta is an organ that provides nutrients and oxygen to your baby and it helps clear the waste that builds up in your baby’s blood. It functions as a support system in the womb.  It is normally implanted in the upper part of the uterus and will be detached from the uterine wall during the last stage of labor. Placenta is linked to the baby via the umbilical cord which is attached to the baby’s abdomen.

During placental abruption, the placenta is completely or partially detached from the uterus before the delivery. Since the support system is collapsed, your baby may not receive the required nutrients and oxygen and is at risk for health problems. This condition usually happens suddenly and causes heavy bleeding in the mother. If the condition is left untreated, both mother and baby are at risk. It is estimated that 1 in 100 women (1 percent) experience this complication.

When placental abruption happens?

Placental abruption usually happens during the third trimester of pregnancy. But this condition is also seen after 20 weeks of pregnancy. Mild forms of abruption (if only a small part of the placenta separates from the wall of the uterus) are usually not dangerous. If the abruption is very severe, your baby is at risk of growth problems, stillbirth and premature birth. Mild forms of placental abruption can sometimes turn to a serious one. In such instances, an emergency C-section has to be initiated and if the C-section is delayed, your baby is at risk of birth asphyxia and brain damage such as hypoxic-ischemic encephalopathy (HIE) and cerebral palsy (CP).

Symptoms of Placental abruption

The following are the signs and symptoms of placental abruption.

·         Vaginal bleeding: Though vaginal bleeding is a symptom of placental abruption, approximately 20% of women don’t experience bleeding. The amount of bleeding is not an indicator of how much placenta has separated. Sometimes there might not be any visible bleeding as the blood gets trapped inside the uterus. In some cases placental abruption might develop slowly which results in light, intermittent vaginal bleeding. Also in such cases, your baby’s development becomes slow and you will end up with a low amount of amniotic fluid.

·         Sudden abdominal or back pain

·         Uterine tenderness or rigidity

·         Repeated uterine contractions

The symptoms may get worse over time. It is highly advisable to consult a doctor immediately if you notice vaginal bleeding in your third trimester.

Causes and risk factors of placental abruption

The exact cause of placental abruption is not clear. The following may be the causes.

·         Trauma or injury to the abdomen like a car accident, fall and physical abuse

·         Placental abruption in previous pregnancy: A woman who had a previous placental abruption carries a 10% risk of abruption in the next pregnancy.

·         Hypertension related problems like preeclampsia

·         Premature rupture of membranes that results in loss of amniotic fluid

·         Women with any complications like uterine infection, umbilical cord problems or high amounts of amniotic fluid

·         Induction of labor

·         Intrauterine growth restriction (IUGR)

·         Maternal age, more than 35

·         Smoking

·         Use of cocaine or amphetamine during pregnancy

·         If you carry twins, triplets

Diagnosis

If you have symptoms of placental abruption, your doctor will perform a physical examination to check for uterine tenderness and rigidity. Blood and urine tests will also be done to identify the possible sources of vaginal bleeding. An ultrasound will be done, though it is difficult to identify the placental abruption in an ultrasound.

Treatment

The treatment for placental abruption depends upon the severity of the abruption and the status of the mother and baby.

·         Mild placental abruption at 24 to 34 weeks: If both mother and baby are doing well, you will be prescribed medicines to speed the development of your baby’s lungs. If the bleeding is stopped, you can return home. Or else you need to be monitored in the hospital.

·         Mild placental abruption at 34 weeks or greater: If you have a mild abruption and are nearing full term, labor is induced or a C-section will be planned. An earlier delivery can likely reduce the risks for further complications.

·         Moderate to severe placental abruption: When there is a significant blood loss and your physician foresee complications to you and your baby, an immediate C-section will be done.

In very rare cases, if the levels of bleeding are out of control, a hysterectomy is done. Hysterectomy will prevent deadly bleeding and other health problems.  

Prevention

Placental abruption cannot be prevented. It is absolutely necessary to reduce the risk factors like not to smoke and use illicit drugs during pregnancy. If you have high blood pressure, work with your healthcare provider and take steps to control it. It is mandatory to use a seat belt when you travel in a car.

Complications

Placental abruption can cause problems to you and your baby.

For the mother

·         Blood loss

·         Blood clotting issues

·         There may be a need for a blood transfusion

·         Maternal hemorrhage

·         Organ failure

·         If the uterine bleeding is out of control, hysterectomy may be required.

For the baby

·         Low birth weight

·         Premature birth

·         Fetal growth restriction

·         Fetus not getting enough oxygen

·         Stillbirth

Sometimes oxygen deprivation can lead to birth injuries and permanent disabilities.

Placental abruption is a serious pregnancy complication and requires close monitoring.