Placental abruption is the separation of the placenta from the uterine lining. This condition usually occurs in the third trimester but can occur any time after the 20th week of pregnancy. Only about 1% of all pregnant women will experience placental abruption, and most can be successfully treated depending on what type of separation occurs.
What are the signs & symptoms of placental abruption?
The signs and symptoms of placental abruption include one or more of the following:
- Vaginal bleeding (although about 20% of cases will have no bleeding)
- Uterine tenderness
- Rapid contractions
- Abdominal pain
- Fetal heart rate abnormalities
Any vaginal bleeding in the third trimester should be reported to your health care provider immediately. Other causes for vaginal bleeding could be placenta previa. Your health care provider will know the proper diagnosis.
What actually happens in placental abruption?
The placenta is part of your baby’s life support system. It transfers oxygen and nutrients to your baby. When the placenta separates from your uterine lining before labor it can interrupt the transportation of oxygen and nutrients to your baby.
Placental abruption can only truly be diagnosed after birth, when the placenta can be examined. There are a few methods that are used to try to make this diagnosis during pregnancy so that proper treatment can be applied. These include:
- Evaluation of patient’s symptoms (bleeding, pain)
- Blood tests
- Fetal monitoring
What is the treatment for placental abruption?
Treatment depends on the severity of the separation, location of the separation and the age of the pregnancy. There can be a partial separation or a complete (also called a total) separation that occurs. There can also be different degrees of each of these which will impact the type of treatment recommended.
In the case of a partial separation, bed rest and close monitoring may be prescribed if the pregnancy has not reached maturity. In some cases, transfusions and other emergency treatment may be needed as well.
In a case with a total or complete separation, delivery is often the safest course of action. If the fetus is stable, vaginal delivery may be an option. If the fetus is in distress or the mom is experiencing severe bleeding, then a cesarean delivery would be necessary.
Unfortunately, there is no treatment that can stop the placenta from detaching and there is no way to reattach it.
Any type of placental abruption can lead to premature birth and low birth weight. In cases where severe placental abruption occurs, approximately 15% will end in fetal death.
What causes placental abruption?
The causes of placental abruption are not completely known. However, women are more at risk for this condition if they:
- Use cocaine during pregnancy
- Are over the age of 35
- Have preeclampsia or hypertension
- Are pregnant with twins or triplets
- Have had a previous placental abruption
- Experience trauma to the abdomen
- Have abnormalities in the uterus
When should I call my health care provider?
You should call your health care provider immediately if you experience bleeding in your third trimester. Only your health care provider can make a proper diagnosis for the cause of late term bleeding. The outcome of a placental abruption diagnosis is improved with fast and accurate treatment.
Compiled using information from the following source:
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 35
American Pregnancy Association, http://www.americanpregnancy.org