Placental abruption occurs when the placenta detaches, in part or in whole, from the uterine wall. Although rare, this condition can be extremely dangerous to both mother and baby.
When the placenta abrupts, the uterus will begin bleeding from the attachment site. While in many cases the blood will drain through the cervix, altering the mother to a problem, in some cases the blood will pool behind the placenta, delaying diagnosis and necessary treatment.
Early abruption may not have any symptoms. While vaginal bleeding is usually the first sign, the amount of blood does not correlate with the severity of the abruption - just a trickle may be seen when in fact the entire placenta has abrupted. Conversely, only a tiny portion may have detached from the uterine wall, yet copious amounts of blood are noted.
Other possible symptoms may include back or abdominal pain, a tender uterus, and fast contractions or tetanic contractions, which are sustained uterine contractions without intervals of relaxation between them.
Blood tests and ultrasounds are commonly used to find the bleeding source, but diagnosis must be based on the situational circumstances and sometimes can't be confirmed until after the birth.
Partial or complete placental abruption can lead to disseminated intravascular coagulation (clotting inside the blood vessels), kidney failure, bleeding into the uterine walls, excessive blood loss requiring a transfusion, and shock. If the bleeding cannot be controlled, sometimes a hysterectomy must be performed. The baby may experience oxygen and blood deprivation, leading to neurological or behavioral impairments and sometimes death.
In most cases, the exact causes of abruptions are unknown. In some cases it is due to abdominal trauma, such as car accidents or falls. Still more rarely, it can be the result of a very short umbilical cord or a very quick reduction in amniotic fluid levels.
The largest risk factor is hypertension (high blood pressure), whether it existed before the pregnancy or developed during pregnancy. Higher rates of placental abruption are also found in women who smoke, consume alcohol and abuse drugs like cocaine. Other factors include maternal age over 40, diabetes, multiples, polyhydraminos (high levels of amniotic fluid), mothers with blood clotting disorders and many previous births.
Placental abruption occurs in only .04 to 3.5 percent of all pregnancies and is most common in the final trimester of pregnancy, but can begin as early as 20 weeks. With appropriate treatment, the prognosis is good for both mother and child.
If a mother experienced a past abruption, a ten percent chance of recurrence exists. Two previous abruptions increase the odds to over twenty percent.
With a mild abruption where the baby is tolerating well and is too young for birth, hospital bed rest may be required. Home bed rest may be allowed if bleeding ceases. Steroid shots may be recommended to develop the baby's lungs in the event that a preterm delivery becomes medically necessary. However, if the condition resolves, mothers are encouraged to walk and may be sent home if conditions improve.
Treatment will depend on the maternal and fetal condition, as well as the stage of pregnancy. If the mother is close to term, around 36 weeks, with minimal abruption, then a very closely monitored natural birth may be possible. If circumstances turn unfavorable, then a c-section will be required.
If you experience any of these symptoms or just feel that something is not quite right, contact your care provider immediately. It's always best to err on the side of caution.
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Page Last Modified by Catherine Beier, MS, CBE
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