Placental abruption is a serious pregnancy condition, most likely to occur in the third trimester of pregnancy. It can have dangerous consequences for both the mother and her unborn baby.
If left untreated, placental abruption can cause dangerous blood loss in the mother, potentially resulting in maternal death and life threatening complications for her baby.
Placental abruption symptoms indicate that the placenta has detached from the wall of the uterus before it should. The placenta is required to provide essential oxygen and nutrients from the maternal system to the baby; without these, the baby is not able to survive. If the placenta separates prematurely, the baby’s supply of oxygen can be severely compromised.
Placental abruption types
A placental abruption can be classified in a number of ways:
- Concealed Placental Abruption – In this case, part of the placenta separates from the uterine wall but the blood is not released. Blood builds up between the placenta and uterine wall, forming a clot but leaving no visible bleeding vaginally
- Revealed Placental Abruption – This type of placental abruption occurs when the lower edge of the placenta pulls away from the uterus and blood escapes through the cervix
- Partial Placental Abruption – This is when only a portion of the placenta separates and the rest remains intact
- Complete Placental Abruption – The entire placenta detaches from the uterine wall.
A placental abruption can be described as either a mild or a severe placental abruption. The severity will depend on how much of the placenta has come away, the amount of bleeding and the number of weeks pregnant you are at the time it happens.
You can learn more about the different types of placental abruption in our article Placental Abruption | What You Need To Know.
What are the Placental Abruption Symptoms and Signs ?
Placental abruption symptoms and signs include:
- Vaginal bleeding
- Abdominal pain
- Uterus is rigid and tender to touch
- Painful contractions or pain between contractions
- Back pain or backache
- Fetal distress
- Reduced fetal movements.
As mentioned above, placental abruption can occur with or without vaginal bleeding. The amount of bleeding can also vary significantly. In a mild placenta abruption, women might only experience light bleeding; a severe abruption can lead to catastrophic hemorrhage.
Placental abruption – no bleeding
The amount of visible bleeding does not always correlate with the severity of the placental abruption. For example, in the case of a concealed abruption, the pregnant woman will not experience vaginal bleeding. The placenta partially separates but the blood remains trapped behind the placenta. However, there might still be significant internal blood loss, which can be just as much of a concern.
What does placental abruption pain feel like?
Placental abruption pain can range from mild to severe.
Some women experience cramping, similar to period type pains; others might experience strong, sharp pain. The pain is usually continuous, rather than pain that comes and goes.
If placental abruption occurs during labor, women are likely to notice uterine contractions that are longer and more intense than those in regular labor; they are also likely to feel pain between their contractions.
A common symptom of abruption is belly pain. The abdomen is likely to feel tender or painful to touch, and can feel rigid rather than soft.
Some women might also experience back ache or a sharp pain that radiates round to their back.
What are the effects of placental abruption on baby?
If left untreated, severe placental abruption can have dire effects on the mother and her baby, including maternal and fetal death in the worse cases.
Heavy bleeding in the mother means a reduced oxygen supply for the baby.
In a severe placental abruption, your baby might need to be born immediately to give her the best chance of survival. This could mean the baby is born prematurely (prior to 37 weeks of pregnancy). Babies born early might require admission to the neonatal unit, depending on their condition and their gestation at the time of birth.
A major concern for babies who are born early is that the baby’s lung development will be immature. This means they’re more likely to have problems breathing or to develop lung disease. You might be offered a medication to help mature your baby’s lungs, if she needs to be born early.
More commonly, if the placenta abruption is mild, it can cause pregnancy complications, such as restriction of the baby’s growth.
Complications for baby
- Premature birth (and associated complications)
- Low birth weight
- Growth problems
- Brain injury caused by lack of oxygen
- Still birth.
Complications for mother
- Antepartum and postpartum hemorrhage
- Blood clotting abnormalities
- Need for blood transfusion
- Acute complications caused by the extreme blood loss, such as kidney failure
- Increased risk of emergency cesarean
- Increased risk of hysterectomy.
How long can a baby survive after placental abruption?
Survival rates following placental abruption will depend on the severity of the abruption and the gestation at the time of birth.
If you and your baby remain well, a mild placental abruption can be treated with close monitoring and extra follow up, in the form of ultrasound scans.
Prompt medical attention and diagnosis of placental abruption will increase your baby’s chances of survival. That’s why it’s important to let your healthcare provider know straight away if you experience any vaginal bleeding, cramping or pelvic pain during your pregnancy.
How is placental abruption diagnosed?
Placental abruption should always be suspected when there is any vaginal bleeding during pregnancy. The presence of bleeding, in addition to abdominal pain, especially in the third trimester, is a strong indicator of placental abruption.
Your care provider will want to perform a physical examination including blood tests and possibly an ultrasound to confirm the diagnosis. Your baby’s heart rate will be monitored closely to make sure the rate and pattern are normal.
Bleeding in pregnancy can have other causes; therefore, it is important to detect the source of the bleeding for the most appropriate clinical practice.
To find out more about other causes of bleeding in pregnancy, read our article Bleeding During Pregnancy | 7 Causes Of Vaginal Bleeding.
How is placental abruption treated?
Once placental abruption is diagnosed, the management and treatment depend on how many weeks pregnant you are and the severity of the abruption.
You might be advised to remain in hospital for a period of time until the bleeding settles. During this time, you and your baby will be monitored closely to ensure you both remain well.
If the placental abruption is mild and you both remain stable, you’ll probably be able to go home and rest for a few days. Extra monitoring and scans might be arranged for the remainder of your pregnancy, to make sure your baby is growing well.
If you experience a severe placental abruption, the safest option for you both might be for your baby to be born early. If the bleeding is serious and doesn’t stop, your baby will probably need to be born immediately, by emergency cesarean section. If the bleeding is less severe, you might be offered the option of induction of labor.
Talk to your doctor or midwife about what the best option for you and your baby might be, based on your situation.
What’s the difference between placental abruption and placenta previa?
There are a number of other causes of vaginal bleeding during pregnancy and placenta previa is one of them. However, placental abruption is different from placenta previa.
Both conditions can cause severe bleeding in the mother.
Placenta previa is a placental condition, where the placenta attaches and grows too low down on the wall of the uterus, covering or partially covering the cervix. The condition is also diagnosed if the edge of the placenta is less than 20 mm from the edge of the cervical opening.
Bleeding caused by placental abruption is usually associated with pain, whereas bleeding caused by placenta previa is usually painless.
Can bed rest help placental abruption?
If placental abruption is mild and the bleeding has settled, your care provider might be happy for you to return home. Bed rest or light duties will probably be recommended for a few days, to allow the bleeding time to settle. After that happens, you’ll be able to return to normal activities.
Can stress cause the placenta to detach?
Increased psychological stress is known to increase the risk of various adverse outcomes in pregnancy, including problems with growth and blood pressure.
Recent research suggests that emotional stress during pregnancy can cause a higher risk of abruption; exactly what causes placental abruption is still unclear. This is an area for further research.
Other risk factors for placental abruption
Some risk factors are:
- Placental abruption (not caused by trauma) in a previous pregnancy
- High blood pressure in pregnancy
- Use of illicit drugs
- Abdominal trauma
- Infection inside the uterus, known as Chorioamnionitis
- Raised maternal age
- Premature leaking of amniotic fluid.
How can I prevent placental abruption?
You cannot always prevent placental abruption. However, the best way to reduce the chances of the placenta detaching from the wall of the uterus too early is to address any underlying health problems and other complications and to keep yourself as healthy as possible during your pregnancy.
High blood pressure and smoking are risk factors for placental abruption; addressing them as early as possible in your pregnancy (or before) gives you and your baby the best chance.
Seek support if you feel unsafe in your relationship or at home. Unfortunately, it’s well documented that incidences of domestic abuse increase dramatically during pregnancy. Abdominal trauma, resulting from a fall or an accident, or from violence, can increase the chances of placental abruption occurring.
Can I have another baby after placental abruption?
Those who have had a previous abruption are less likely than other women to have another baby, but it’s not completely off the cards. However, there are some things you should know.
It’s possible to have another baby after having a placental abruption in a previous pregnancy but it’s important to discuss the details with your health care provider.
The chances of it occurring again in a future pregnancy are about 1 in 10, or 10%.