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Placental Abruption

(Premature Separation of Placenta; Ablatio Placentae; Abruptio Placentae)

Definition

Placental abruption occurs when the placenta separates from the uterus before the fetus is delivered. The placenta is the organ that provides nourishment for the fetus while it is still in the uterus. In a healthy pregnancy, the placenta remains attached to the uterine wall until after the fetus is delivered.
Some form of the condition affects about one in every 150 births. In very severe forms, placental abruption can cause death to the fetus. This occurs less commonly. Death of the mother from placental abruption is very rare.
Placental abruption can cause:
  • Premature delivery
  • Fetal anemia
  • Low birth weight
  • Significant blood loss for the mother
  • Fetal death
Placental Abruption
Placental Abruption
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Causes

The direct cause of placental abruption is not clearly understood. It may be a combination of several events. These may include:
  • Impaired formation and structure of the placenta
  • Low oxygen levels inside the uterus
  • Rupture of maternal artery or vein which causes bleeding behind the placental wall
  • Injury to the abdomen from an accident or a fall
  • Sudden decrease in the volume of the uterus, from significant loss of amniotic fluid or from the delivery of a first twin

Risk Factors

Factors that may increase your chance of developing placental abruption:
  • Previous placental abruption in a prior pregnancy
  • High blood pressure during pregnancy
  • Pregnancy during older age
  • Multiple previous deliveries
  • Excessively distended uterus
  • Smoking during pregnancy
  • Drug misuse, especially cocaine

Symptoms

In the early stages, you may not have symptoms. When symptoms occur, they may include:
  • Vaginal bleeding
  • Abdominal pain
  • Back pain
  • Rapid contractions
  • Soreness in the uterus
  • Feeling faint
  • Baby moving less

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A pelvic exam will also be done to examine your reproductive organs.
Tests may include:
  • Ultrasound
  • Blood coagulation profile to determine how long it takes for your blood to clot

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Intravenous Treatments

Fluids may be given by IV to replace lost fluids. Blood transfusions may also be given to replace lost blood supply.
The mother and fetus will be carefully monitored for signs of distress or shock, including abnormal heart rates.

Emergency Cesarean Delivery

If danger exists for mother or fetus, an emergency cesarean section may be done. If both the mother and fetus are at low risk of complications and the fetus is full-term, the mother may deliver vaginally.

Prevention

To help reduce your chance of getting placental abruption, take the following steps:
  • Avoid taking drugs and smoking during pregnancy.
  • Receive proper and regular prenatal care throughout the pregnancy.
  • Promptly treat conditions such as high blood pressure .

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org

American Pregnancy Association http://www.americanpregnancy.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health http://www.womenshealthmatters.ca

References

Bleeding in pregnancy, placenta previa, placental abruption. Lucile-Packard Children's Hospital website. Available at: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/hrpregnant/bleed.html. Accessed June 5, 2013.

Neilson JP. Interventions for treating placental abruption. Cochrane Database for Syst Rev. 2003;(1):CD003247.

Placental abruption. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 14, 2013. Accessed June 5, 2013.

Placental abruption: abruptio placentae. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/placentalabruption.html. Updated November 2006. Accessed June 5, 2013.

Tikkanen M. Etiology, clinical manifestations, and prediction of placental abruption. Acta Obstet Gynecol Scand. 2010;89(6):732-740.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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