Placental Abruption

What is placental abruption?

Placental abruption is the early separation of the placenta from the wall of the uterus. It occurs in less than 1% of pregnancies. The placenta is an organ that grows in the uterus during pregnancy to provide nourishment and oxygen to the baby.

How does it occur?

Normally the placenta separates from the uterus and is delivered right after the birth of the baby. When placental abruption occurs, the placenta starts to tear away from the uterus before the baby is born. It can cause serious problems for the baby and the mother.

You are at higher risk for placental abruption if you:

• become pregnant after age 35
• have had more than 4 or 5 children
• are pregnant with twins or triplets
• have high blood pressure
• use illegal drugs
• have diabetes
• have had a previous abruption
• have to have your baby turned into the correct position for delivery (external cephalic version).

What are the symptoms?

The symptoms of placental abruption are:

• contractions that don't stop
• pain in the uterus
• tenderness in the abdomen over the uterus
• vaginal bleeding (sometimes).

How is it diagnosed?

Your health care provider will give you a physical exam, looking for signs of blood loss. The following tests may be done:

• blood tests
• ultrasound scan to look for a blood clot behind the placenta
• nonstress test to check the baby's heart rate.

How is it treated?

The treatment for placental abruption depends on:

• how much of the placenta has separated from the uterus
• how close the pregnancy is to full term
• your health and whether you have other problems, such as high blood pressure
• whether you have blood clotting problems
• the amount of blood you have lost
• the baby's health.

If the separation of the placenta is small, the baby's heart rate patterns are normal, and your condition is stable, you may be able to go home and continue the pregnancy with frequent checkups. Your health care provider may recommend that you limit your activities (including not having sex) and that you rest in bed at home.

If you are admitted to the hospital, you will be given intravenous (IV) fluids. A fetal monitor will be used to check the baby's heart rate patterns. If the separation is moderate to severe, your blood pressure, pulse, and amounts of urination will be closely checked. Lab tests will be run on your blood to check its ability to clot. You may be given blood transfusions.

If the separation is moderate to severe but you and the baby are stable, your health care provider may induce labor and perform a vaginal delivery. If the baby has abnormal heart rate patterns or if you are losing a lot of blood, your provider will deliver the baby right away surgically with a cesarean section (C-section).

How long will the effects last?

Sometimes placental abruption begins and then stops without treatment. As long as you and the baby are healthy, your pregnancy can continue with frequent checkups by your provider. If tests of the baby show that everything is normal, a mild case of placental abruption will probably have no long-term effects on your health or your baby's health.

A moderate to severe separation of the placenta may have the following effects on you after delivery:

• A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
• Your uterus may not contract properly after delivery so you may need medication to help the uterus contract.
• You may have problems with blood clotting for a few days.
• A severe case of shock may affect other organs of your body, such as the liver, kidney, and pituitary gland.

Placental abruption may have the following effects on the baby:

• If a large amount of the placenta separates from the uterus, the baby may have problems until delivery.
• The baby may be premature and need to be placed in the newborn intensive care unit. He or she might have problems with breathing and feeding.
• The baby may not get enough nutrients and oxygen from the placenta.
• The baby may have a low level of oxygen in the blood after birth.
• The newborn may have low blood pressure or a low blood count.
• If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.

How can I help take care of myself?

• Limit your activity and rest in bed.
• Do not have sexual intercourse.
• Avoid bending and lifting.
• Take iron regularly if your provider prescribes it.
• Call your provider right away if you start having contractions or you have pain or bleeding.

What can be done to help prevent placental abruption?

Good prenatal care and a healthy diet may prevent high blood pressure during pregnancy. Prevention of high blood pressure decreases the risk of abruption.

Placental abruption caused by drug abuse can be prevented if the mother stops abusing drugs.

If you have diabetes, keep your diabetes in good control and see your health care provider often.

Despite these preventive steps, placental abruption may occur again in the next pregnancy. If you have had a placental abruption and are pregnant again, be sure to tell your health care provider about it. Get plenty of rest, take vitamins, and immediately report any contractions or bleeding to your provider.