Placental abruption happens when some or all of the placenta starts to detach from the uterus wall before your baby is born.
During pregnancy placental abruption often happens very suddenly and is a medical emergency.
Although placental abruption is rare (affecting less than 1% of all pregnant women), it’s important to know about it.
#1: What is placental abruption?
Before we talk about placental abruption, let’s take a quick look at the role and function of the placenta.
The placenta is a temporary organ and develops only during pregnancy in response to conception.
It’s your baby’s lifeline during pregnancy. One side attaches to the lining of your uterus and the other side attaches to your baby via the umbilical cord. Oxygen and nutrients are transferred to your baby, and waste products are taken away via the umbilical cord.
To find out more about this fascinating organ, be sure to read What Is A Placenta? 10 Amazing Facts.
The placenta normally detaches from the uterine wall after your baby is born. However, with placental abruption the placenta begins to detach too early, before your baby is born.
Placental abruption is a serious pregnancy complication that disrupts the supply of oxygen and nutrients to your baby. It also causes severe blood loss in mothers, which can be harmful.
#2: What are placental abruption symptoms?
Three main signs and symptoms of placental abruption occurs either separately or all together:
- Sudden onset of unexpected dark and heavy vaginal blood loss
- Abdominal pain and tenderness and/or backache
- Reduced fetal movement.
These symptoms become worse over time as the placenta separates so it’s important to seek immediate medical advice if you experience any of them – especially bleeding in the third trimester.
#3: What to do if you suspect you have placental abruption
You should always inform your OB GYN if there’s a sudden onset of bright red or dark vaginal bleeding. Take note of other symptoms like back pain or contractions.
Depending on the severity of your symptoms, you might be admitted for further investigations and observation. It’s always advisable to put on a sanitary pad, as this will give your health care provider a good idea of the colour and amount of bleeding.
#4: Is vaginal bleeding always a sign of placental abruption?
It’s always alarming to notice vaginal bleeding during pregnancy. There are many causes of bleeding and many of them are normal and expected.
Spotting is common in the first trimester and is often associated with implantation. You might experience vaginal bleeding after sexual activity, which is normal.
In the last weeks of pregnancy it’s common to see spots of blood in your underwear. This spotting is caused by burst capillaries as your cervix prepares for labour. Always take note of the colour, the amount and any other associated symptoms, like pain or discomfort. Heavy bleeding should always be reported to your health care provider.
#5: What causes placental abruption?
The exact cause of placental abruption isn’t known, but there are several risk factors:
- Previous placental abruption
- Blunt trauma to the belly during pregnancy, especially in the third trimester
- History of smoking or drug use (especially cocaine and amphetamines)
- Infections in the uterus
- Multiple pregnancies (twins or more)
- Mother becoming pregnant after the age of 35.
- Chronic hypertension (raised blood pressure that existed before you became pregnant)
- Pre-eclampsia (raised blood pressure that starts during pregnancy).
Having one or more of these risk factors doesn’t mean you’ll have a placental abruption.
#6: Can you see placental abruption on ultrasound?
To diagnose placental abruption your care provider will perform a physical examination, including a blood test, urine tests and ultrasound. Your baby will be monitored as well.
Expect your care provider to ask you about:
- How long ago the bleeding/or pain began
- Any trauma or activity before symptoms started
- Severity and location of the pain (if you’re experiencing pain)
- Amount and colour of blood loss (make sure to use a maternity pad and bring any discarded pads or towels with you)
- If you’ve had a previous abruption (if this isn’t your first pregnancy)
- If you’ve a history of high blood pressure (hypertension)
- If you have a history of substance abuse (specifically cocaine and amphetamines)
- If you are (or have previously been) a cigarette smoker.
This information will help your care provider to make a diagnosis and plan your treatment according to the severity of placental abruption.
#7: How do you treat placental abruption?
Unfortunately, your placenta can’t be reattached or fixed, only managed. The treatment depends on how severe the abruption is and how many weeks of pregnancy you are. The health of you and your baby is also a consideration following the abruption.
Placental abruption is classified as mild, moderate or severe, according to the combination and severity of symptoms.
Mild placental abruption (represents approximately 48% of all cases):
- No vaginal bleeding to mild vaginal bleeding
- Slight abdominal tenderness in the area of the uterus or back pain
- No fetal distress
- Normal maternal heart rate and blood pressure
Moderate placental abruption (represents approximately 27% of all cases):
- No vaginal bleeding to moderate vaginal bleeding
- Moderate to severe tenderness of the uterus, with possible back to back contractions
- Changes in maternal heart rate and blood pressure
- Fetal distress
Severe placental abruption (represents approximately 24% of all cases):
- No vaginal bleeding to heavy vaginal bleeding
- Very painful, rigid uterus
- Severe changes in maternal heart rate and blood pressure; shock
- Changes in blood clotting
- Severe fetal distress and death.
Depending on the severity of the abruption, you might only need careful monitoring. With severe placental abruption you’ll need to give birth immediately.
#8: Can a baby survive placental abruption?
Partial separation is a serious complication and requires immediate medical attention. The treatment and outcome depend on the severity of the abruption and how many weeks of pregnancy you are.
If the bleeding is mild you’ll be admitted to hospital to monitor the amount and colour of your bleeding with regular pad checks. Your baby will be monitored using a handheld doppler or CTG (see more about monitoring here) for signs of fetal distress. Your doctor will check to see your baby is getting enough oxygen.
You might be offered steroid injections to strengthen your baby’s lungs and prevent respiratory distress if there are signs of premature labour.
You might be discharged home with instructions to take it easy as long as:
- The bleeding stops
- Your baby shows no signs of distress or growth problems
- There are no signs of premature labour.
Complete separation of the placenta is a medical emergency and can be fatal. If the placenta separates completely from the lining of the uterus, your baby won’t get enough oxygen and nutrients.
Swift medical attention is required to stop the bleeding and deliver the baby.
#9: Is a vaginal birth possible with placental abruption?
Something many women wonder is if it’s possible to still give birth vaginally with placental abruption. This depends on the severity of the bleeding and your baby’s health.
Labour will be stalled for as long as it’s safe to do so. An emergency c-section is often necessary if the bleeding persists or worsens, or if your baby shows signs of distress.
The closer you are to 37 weeks, the more likely you can attempt a closely monitored vaginal birth. This will be closely monitored so that if the placenta separates, your health care providers can act immediately to keep you and your baby safe.
A vaginal birth isn’t usually possible if the bleeding is severe. In most cases, an emergency c-section will be performed to save the life of your baby.
#10: Is it possible to miss a placental abruption?
Sometimes the bleeding remains hidden between the separated lining of the uterus and behind the placenta. This is called a ‘silent abruption’ and it can go unnoticed unless it’s accompanied by abdominal pain and tenderness.
The blood collects behind the placenta and next to the lining of the uterus, causing a retroplacental clot (‘retro’ means ‘behind’). This can sometimes be seen on ultrasound or is diagnosed after birth.
The amount of pain experienced depends on the severity of the abruption. A mild partial separation might cause tenderness that feels like a bruise. A more severe separation is acutely painful and the pain persists until treated.
Seek medical advice for any pain or tenderness that starts suddenly and feels abnormal, even if there is no bleeding.
#11: Can you prevent placental abruption?
As mentioned, we don’t really know what causes placental abruption to occur but there are risk factors linked to this pregnancy complication.
A healthy placenta means a healthy pregnancy and a healthy baby, as well as a positive birth experience.
Hypertension and placental abruption
Studies show almost 45% of placental abruptions are associated with hypertensive disorders of pregnancy. In other words, high blood pressure during pregnancy increases the risk of placental abruption.
One of the most common causes of high blood pressure during pregnancy is pre-eclampsia. Signs of pre-eclampsia include an increase in blood pressure, and protein in the urine, usually after 20 weeks of pregnancy.
The increase can be sudden or gradual. If preeclampsia is left untreated the symptoms can worsen and lead to seizures.
Regular antenatal appointments include blood pressure and urine checks to rule out pre-eclampsia developing.
In a retrospective study by the American Heart Association, 265 cases of abruption were reviewed. The incidence of placental abruption was highest with eclampsia (23.6%), followed by chronic hypertension (10.0%) and pre-eclampsia (2.3%). This data suggests hypertension is associated with increased risk of abruption and that the degree of risk is dependent upon the type of hypertensive disorder.
Can smoking cause placental abruption?
Cigarette smoking has many unwanted side effects during pregnancy and has been shown to increase the overall risk of placental abruption.
This study showed the risk of abruption to be increased by 40% for each year of smoking prior to pregnancy.
Trauma and placental abruption
Blunt trauma to your belly during pregnancy, especially in the third trimester, can increase the risk of placental abruption. Blunt trauma is any injury caused by a forceful impact, such as a motor vehicle accident, an accidental fall on a hard surface, or a physical attack with a blunt object.
When travelling by car it’s important to wear your seat belt correctly to protect you and your baby. The shoulder belt should extend snugly across your chest and away from your neck. There should be no extra slack at all. The lap belt should be secured below your belly and fit snugly around your hips and pelvic bone.
#12: Can you have a baby after placental abruption?
Yes, absolutely, you can have another baby. It’s important to inform your care provider of your medical history. A previous placental abruption is a known risk factor for subsequent abruption. It doesn’t mean it will definitely happen again though.
You’ll be advised to take it easy during pregnancy. You might even be placed on bed rest if you have any bleeding after the second trimester. Your blood pressure will also be carefully monitored throughout your pregnancy.
#13: Placenta previa vs placental abruption
One last note. Don’t confuse placenta previa with placental abruption; they are completely different. If you’ve been diagnosed with placenta previa it means your placenta is low lying and possibly covering the mouth of your cervix.