Placental abruption, also known as abruptio placentae, is a serious pregnancy complication in which the placenta partially or completely separates from the inner wall of the uterus before the baby is born. The placenta is an organ that develops during pregnancy and provides oxygen and nutrients to the growing fetus while removing waste products. Placental abruption can deprive the fetus of oxygen and nutrients, leading to serious health risks for both the mother and the baby.
What types of placental abruption are there?
The placenta is a temporary organ that connects the growing fetus to the uterus during pregnancy. It attaches to the wall of the uterus, usually on the top or side, and acts as a life preserver that delivers nutrients and oxygen to the fetus through the umbilical cord. The placenta also removes waste from the fetal blood. Types of placental abruption:
- partial placental abruption (occurs when the placenta is not completely separated from the wall of the uterus);
- complete or total placental abruption (occurs when the placenta is completely separated from the wall of the uterus);
- known placental abruptions (have moderate to heavy vaginal bleeding that can be seen);
- hidden placental abruption (vaginal bleeding is slight or absent, as blood is retained between the placenta and the wall of the uterus).
It is also important to distinguish abruption from placenta previa. In placenta previa, the placenta completely or partially covers the mother’s cervix. It is also called a low-lying placenta, which blocks the exit from the uterus. Even though the placenta is in a difficult position, it is still attached to the uterus. When the placenta separates from the uterus, it is a placental abruption. Both conditions can cause vaginal bleeding during pregnancy and childbirth.
What are the causes of placental abruption?
In about 1 in 100 pregnancies, placental abruption occurs. This condition usually occurs in the third trimester, but can occur any time after 20 weeks of pregnancy until delivery. The cause of placental abruption is often unknown. Certain lifestyle choices or abdominal trauma can increase the risk of placental abruption. Risk factors that increase the likelihood of placental abruption:
- trauma or damage to the uterus (such as a car accident, fall, or blow to the abdomen);
- multiple pregnancy (twins or triplets);
- high blood pressure (hypertension), gestational diabetes, or preeclampsia;
- smoking or drug use;
- short umbilical cord;
- mother’s age 35 years or older;
- uterine fibroids;
- thrombophilia (blood clotting disorder);
- premature rupture of membranes (water breaks before the fetus ripens);
- rapid loss of amniotic fluid.
Also at risk are women who have experienced placental abruption during previous pregnancies. About 15% of women experience placental abruption again and up to 25% — if the abruption occurred in two previous pregnancies.
What are the symptoms of placental abruption?
Placental abruption can present with a range of symptoms, which can vary depending on the severity of the abruption. Some common symptoms of placental abruption include:
- vaginal bleeding. This is one of the hallmark symptoms of placental abruption. The bleeding may be sudden and heavy or gradual and light. However, not all cases of placental abruption present with vaginal bleeding;
- abdominal pain or tenderness. Many individuals with placental abruption experience abdominal pain or tenderness. The pain may be constant or intermittent and may be localized to one area of the abdomen or spread throughout;
- uterine contractions. Placental abruption can cause uterine contractions, which may feel like abdominal cramping or tightening. These contractions may be frequent, prolonged, or more intense than typical Braxton Hicks contractions;
- back pain. Some individuals with placental abruption report experiencing back pain, which may be sharp or dull and may radiate from the lower back to the abdomen;
- fetal distress. Placental abruption can lead to fetal distress, which may manifest as decreased fetal movement or abnormalities in fetal heart rate, such as tachycardia (rapid heart rate) or bradycardia (slow heart rate).
It’s important to note that not all cases of placental abruption present with all of these symptoms, and some individuals may experience no symptoms at all. Additionally, the severity of symptoms can vary depending on factors such as the extent of placental separation and the gestational age of the fetus.
If placental abruption is suspected, it is essential to seek immediate medical attention. Placental abruption is a medical emergency that requires prompt evaluation and treatment to reduce the risk of complications for both the mother and the baby. A healthcare provider can perform a physical examination, ultrasound, and other tests to assess the mother and baby’s condition and determine the appropriate course of action.
What are the consequences of placental abruption for the child and mother?
Placental abruption can be life-threatening for the fetus and sometimes for the woman. Complications of placental abruption for a baby include:
- premature birth;
- low birth weight;
- growing pains;
- brain injury due to lack of oxygen;
- stillbirth.
Possible complications for a pregnant woman include blood loss, clotting problems, the need for blood transfusions, and kidney failure. In rare cases, a hysterectomy (removal of the uterus) is necessary if uterine bleeding cannot be stopped.
How is placental abruption treated?
Once the placenta has separated from the uterus, it cannot be repaired or repaired. Treatment is selected taking into account the following factors:
- severity of detachment;
- gestational age and gestational age of the fetus;
- signs of fetal distress;
- the amount of blood the woman has lost.
Typically, the severity of the abruption and the gestational age of the fetus are the two most important factors if the fetus is not yet full term. In case of mild detachment, the gynecologist leaves the woman under observation until the 34th week of pregnancy; in case of severe detachment, a decision may be made about immediate childbirth.
If the fetus is close to full term, the woman has a mild abruption, and the baby has a stable heart rate, a vaginal birth with close monitoring is possible. This is usually detected around 34 weeks of pregnancy. In case of severe abruption, an emergency caesarean section is prescribed.
How to prevent placental abruption?
Preventing placental abruption entirely is difficult, as many risk factors for the condition are not entirely modifiable. However, there are steps pregnant individuals can take to reduce their risk of placental abruption and promote overall pregnancy health. Here are some recommendations:
- Attend prenatal care appointments:. Regular prenatal care is essential for monitoring the health of both the mother and the baby throughout pregnancy. Healthcare providers can identify and manage risk factors for placental abruption and provide guidance on maintaining a healthy pregnancy.
- Manage chronic health conditions. If you have chronic health conditions such as high blood pressure, diabetes, or clotting disorders, work with your healthcare provider to manage these conditions effectively during pregnancy. Controlling these conditions can help reduce the risk of complications, including placental abruption.
- Avoid tobacco, alcohol, and illicit drugs. Smoking, excessive alcohol consumption, and illicit drug use increase the risk of placental abruption and other pregnancy complications. Avoiding these substances altogether is essential for promoting a healthy pregnancy.
- Practice safety measures. Take precautions to avoid physical trauma or injury during pregnancy. Wear seat belts while driving or riding in a car, use appropriate safety equipment during physical activities, and take steps to prevent falls or accidents.
- Monitor blood pressure. High blood pressure during pregnancy, including conditions such as pre-eclampsia and gestational hypertension, increases the risk of placental abruption. Attend prenatal appointments regularly to monitor blood pressure and receive appropriate management if hypertension develops.
- Maintain a healthy lifestyle. Eat a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and dairy products. Stay physically active with exercises approved by your healthcare provider. Get adequate rest and manage stress effectively.
- Avoid excessive weight gain. Excessive weight gain during pregnancy can increase the risk of complications, including placental abruption. Follow your healthcare provider’s recommendations for healthy weight gain during pregnancy.
- Report symptoms promptly. If you experience symptoms such as vaginal bleeding, abdominal pain, contractions, or decreased fetal movement, seek medical attention promptly. Early detection and treatment of placental abruption can help reduce the risk of complications.
While it may not be possible to prevent placental abruption entirely, taking these steps can help reduce your risk and promote a healthy pregnancy. It’s essential to work closely with your healthcare provider throughout pregnancy to address any concerns and receive appropriate care.