Placental Abruption

Placental abruption is the premature detachment of the placenta either partial or completely prior to the birth of the fetus. This can occur when the vascular rupture of a spiral artery leads to the resulting hematoma which peels the placenta off the decidua. It is the most concerning complications of pregnancy because it occurs in 0.4-1% of pregnancies and is associated with one third of all perinatal deaths.

Possible Causes

Though there is no known exact cause of placental abruption. Here are a few things women that have had placental abruption had in common: –

  • Trauma or injury to the abdomen. This can be due to a fall or injury causing a rapid loss of fluid that surrounds and cushions the baby in the uterus.
  • Having experienced placental abruption in a previous pregnancy. Studies have shown that if you have had one before you have a 10% chance of it happening again.
  • Your water breaks before 37 weeks. If this happens, it can trigger early labor.
  • You have high blood pressure. Hypertension increases the risk of abnormal bleeding between placenta and the wall of the uterus.
  • You smoke cigarettes. Studies have shown that smoking cigarettes raises the chances by 40%.
  • You are pregnant with multiple babies. Sometimes the first baby can make the placenta break before the delivery of the second baby.
  • You have sickle cell anemia. Women with sickle cell anemia can more likely have adverse outcomes in pregnancy. During pregnancy symptoms might be more severe.
  • Getting pregnant much later in life. Getting pregnant after the age of 35 puts you at a higher risk of having placental abruption. However, in most cases the women were over 40 years.
  • Doing drugs. Placental abruption occurs in 10% of women that have done drugs in the third trimester.

Types of Placental Abruption

Partial Abruption

This occurs when the placenta does not completely detach from the uterine wall.

Complete or Total Placental Abruption

This occurs when the placenta completely detaches from the uterine wall. There is more vaginal bleeding associated with this type of abruption.

Revealed Placental Abruption

The dissection occurs along the uterine wall and the blood escapes through the cervix. In this case, there would be moderate to severe vaginal bleeding.

Concealed Placental Abruption

There, blood is trapped between the placenta and uterine wall. Therefore, there will be little or no vaginal bleeding.

Symptoms

Placental Abruption

This condition occurs late in pregnancy. It is important to note that pregnant women with placental abruption will not all have the same symptoms. Here are some symptoms experienced: –

  • Vaginal bleeding. This is the main symptom of placental abruption though not every person with placental abruption will have this symptom. This can occur in the third trimester.
  • Abdominal pain. The stomach would be tender when touched. An injury may tear the placenta from the wall of the uterus.
  • Back pain. Women may suffer from lower back pains. This may happen if there is a concealed abruption. Here, the blood is behind the placenta. So, in this case, there won’t be any sign of vaginal bleeding.
  • Uterine tenderness or rigidity. This pain occurs when the muscles in the uterus contract or tighten. It feels like cramping or you will feel a heaviness in the pelvic area, lower back or stomach.
  • Uterine contractions. Coming right after each other; if there are uterine contractions that come right after each other and do not relax, you should contact a health care professional.
  • Feeling faint. Feeling faint or lightheaded is a symptom associated with placental abruption. You might not only feel faint but confused, restless or very weak.
  • Not feeling the baby move as much as before. If the baby is not moving as per usual this could be a sign of concern and you should contact a health care professional.
Placental Abruption

Complications

  • Decreased oxygen levels to the baby. If the placenta partially or completely detaches, this can cause a decreased amount of oxygen and nutrients getting to the baby. This can lead to much more serious complications.
  • Still birth. This can be due to the decreased levels of oxygen to the baby. This can also happen through maternal hemorrhage, a condition where the blood from the fetus enters the mother’s circulation. This can also cause still birth or neurological injury in the fetus.
  • Maternal blood loss that leads to shock. When blood is loss, it can lead to maternal hypovolemic shock.
  • You may have to have an emergency hysterectomy. If the bleeding cannot be controlled, the uterus may have to be surgically removed.
  • Maternal death. Maternal death can happen because of the significant amount of blood loss if not treated.
  • Low birth weight. Studies have shown that placental abruption is associated with low birth weight.
  • Growth issues. Studies have shown that children who survive after placental abruption are at higher risk for conditions such as cerebral palsy, neonatal apnea etc.
  • Premature birth. Studies have shown that 10% of placental abruption cases result in premature birth.
Placental Abruption

Diagnosis

Information that may be used to diagnose placental abruption are: –

  • Medical history
  • Having a physical examination whereas they would check the tenderness and the time of the uterus
  • Doing blood tests
  • Ultrasound is one of the important tests that are done to check if there is any placental abruption.
  • Fetal heartbeat monitoring
Placental Abruption

Prevention

Placental abruption is difficult to prevent. The risk can be reduced by not smoking or using illegal drugs. Also, avoid medicines that are not prescribed by your doctor. If you have high blood pressure before pregnancy, it would be a good thing to work with a health care professional.

Always wear seat belts in vehicles in case of an accident. You can prevent some amount of trauma to the abdomen by doing this. If you have had an abruption in a previous pregnancy, it is always good to talk to your doctors and let them guide you. Take folic acid as recommended by your doctor.

Placental Abruption

Treatment

All cases of suspected placental abruption are treated differently. Suspected patients should be monitored closely. These checks are usually done at a hospital. These checks usually consist of the checking of vital signs of both mother and baby. Since all cases are different, treatment depends on the case and the severity of the placenta abruption.

If the case is mild, the doctor will still do regular checkups, but you will not be monitored as rigid as someone that has a severe case.

If the case is a little more difficult and it is early in the pregnancy, the doctor may recommend the need for you to stay in the hospital until it is safe for staff to induce labor.

In the latter stage of your pregnancy (this is when most placental abruptions occur), the doctor will probably opt for a delivery. It can be via vaginal birth but if the symptoms become more severe, a C-section will have to be done.

For severe cases, an immediate delivery is the safest for both mother and baby.

Placental abruption is usually identified through a physical exam and an ultrasound.

Placental Abruption
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