Placenta Abruptio

Topic Overview

What is placenta abruptio?

Placenta abruptio is a problem with the placenta during pregnancy. The placenta is a round, flat organ that forms during pregnancy to give the baby food and oxygen from the mother. During a normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until the baby has been born. But with placenta abruptio, the placenta breaks away, or abrupts, from the wall of the uterus too early, before the baby is born. This problem can cause:

• Premature birth.
• Low birth weight.
• Major blood loss in the mother.

Placenta abruptio can be very harmful for both the mother and the baby. In rare cases, it can cause death.

See a picture of placenta abruptio .

Placenta abruptio is also called abruptio placenta or placental abruption. It affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester , but it can happen at any time after the 20th week of pregnancy.

What causes placenta abruptio, and how can you lower your risk?

Doctors aren't sure what causes placenta abruptio. But there are things that raise a woman’s risk for an abruption. These things are called risk factors. If you avoid them, you can lower your risk.

Common risk factors for placenta abruptio include:

• High blood pressure (140/90 or higher). This is the most common risk factor linked to placenta abruptio, whether the high blood pressure is chronic (long-term) or is caused by the pregnancy ( preeclampsia ).
• Having a placental abruption in the past.
• Smoking during pregnancy.

Less common risk factors for placenta abruptio include:

• Using cocaine.
• Having a scar from a past surgery or a uterine fibroid where the placenta has attached to the wall of the uterus.
• Having an injury to the uterus. This could happen in a car accident.
• Premature rupture of membranes for 24 hours or more, especially when there is an infection in the uterus.

What are the common symptoms?

If you have placenta abruptio, you may notice one or more warning signs. Call your doctor right away if you are pregnant and have any of these symptoms:

• Light or moderate vaginal bleeding. Bleeding caused by an abruption depends on where the abruption is and how long it has taken for the blood to pass.
• A uterus that hurts or is sore. It might also feel hard or rigid.
• Signs of early labor. These include regular contractions and aches or pains in your lower back or belly.

Call 911 or emergency services right away if you have:

• Sudden or severe pain in your belly.
• Severe vaginal bleeding .
• Any symptoms of shock . These include feeling lightheaded or like you are going faint; feeling confused, restless or weak; feeling sick to your stomach or vomiting; and having fast, shallow breathing.

You can't really tell how serious an abruption is by the amount of vaginal bleeding. There might be a serious problem even if there is only a little bleeding. Sometimes the blood can be trapped between the placenta and the wall of the uterus. In rare cases, symptoms of shock will be the only signs that there is a problem.

How is placenta abruptio diagnosed?

Your doctor will ask questions about your symptoms and will check your baby’s heart rate. You may have an ultrasound test. Your doctor might also do a blood test to see if you're anemic from losing blood.

If your doctor thinks that you have a placental abruption, you'll likely have to stay in the hospital for at least a few hours. Your doctor will need to find out how severe the abruption is, if it is getting worse, and if it is affecting your baby.

How is it treated?

The kind of treatment you will have depends on:

• How severe the abruption is.
• How it is affecting your baby.
• How close your due date is.

If you have a mild abruption, it may get better on its own. You may just be closely watched for the rest of your pregnancy. You may not have to stay in the hospital.

A medium to severe abruption means that you will likely have to stay in the hospital so that the baby's health can be watched closely. In most cases, the baby will need to be delivered, sometimes by emergency cesarean section .

Frequently Asked Questions

Symptoms

Not every woman with placenta abruptio has telltale symptoms.

If you have placenta abruptio, you may notice one or more symptoms, including:

• Vaginal bleeding . Depending on the location and amount of separation, vaginal bleeding varies in amount (scant to heavy) and color (bright to dark red). Light vaginal bleeding does not necessarily indicate a minor problem. In some cases, a large amount of blood can be pooled between the placenta and the uterine wall, resulting in little or no vaginal bleeding.
• Uterine tenderness or pain. The uterus may feel hard or rigid.
• Signs of preterm labor. In some women with placenta abruptio, labor symptoms are the first sign of trouble. Labor symptoms can include:
  • Regular contractions.
  • Pain in the abdomen or back. This pain can be sharp or aching.

In rare cases, when heavy blood loss is retained in the uterus behind the placenta, the only signs of placenta abruptio are symptoms of shock. Early signs of shock (most of which are present at the same time) include:

• Lightheadedness or a feeling that you are about to pass out.
• Restlessness, confusion, or feelings of fear or anxiety.
• Shallow, rapid breathing.
• Moist, cool skin or possibly profuse sweating.
• Weakness.
• Thirst, nausea, or vomiting.

High blood pressure (hypertension) is the most common risk factor associated with placenta abruptio. For more information, see the topic Preeclampsia and High Blood Pressure During Pregnancy.

Exams and Tests

A separation of the placenta from the uterine wall, or placenta abruptio , can be difficult to identify. Diagnosis is based on a physical exam, a medical history, and a process of elimination. Testing may include:

• Fetal heart monitoring, to assess the fetus's condition and check for contractions of the uterus.
• An ultrasound test, which can detect about 50% of placental abruptions. ¹ A negative ultrasound result does not necessarily guarantee that the placenta is intact.
• A blood test for anemia . A woman with placenta abruptio can become anemic from excessive blood loss.

Treatment Overview

A placenta that has separated from the uterine wall ( placenta abruptio ) cannot be repaired. Until its severity can be assessed, placenta abruptio is considered a medical emergency. If you have suspected or diagnosed placenta abruptio, you will need to be observed in the hospital. Some abruptions can get worse quickly and become life-threatening for both you and your fetus.

If your blood type is Rh-negative and you have placenta abruptio, you will have a RhoGAM shot. This is because your fetus could be Rh-positive. Bleeding from an abruptio can mix the Rh-positive blood with yours. The RhoGAM prevents your immune system from attacking the Rh-positive blood.

Placenta abruptio is usually treated by an obstetrician or perinatologist .

Mild placenta abruptio

If placental separation is minor, vaginal bleeding is light, and your fetus is not in distress, you may be observed in the hospital for several hours or several days. For the remainder of your pregnancy, you'll probably be advised to avoid strenuous activities, and you and your fetus will need to be monitored regularly.

If you are in preterm labor, the separation is minor, and you are far from your due date, you may be given tocolytic medication to stop labor. For more information, see the topic Preterm Labor.

Moderate to severe placenta abruptio

If placental separation is moderate to severe, or if it causes a life-threatening condition called disseminated intravascular coagulation (DIC), rapid delivery is almost always necessary. Although vaginal delivery is sometimes possible, the need for rapid delivery increases the likelihood of a cesarean (C-section) . In rare cases of heavy bleeding that won't stop, the uterus is surgically removed ( hysterectomy ).

Depending how much blood you have lost and whether you have disseminated intravascular coagulation, you may need a transfusion of blood or blood-clotting products, such as platelets .

How well your baby does after a placental abruption depends on how prematurely he or she is delivered and how well the placenta was able to circulate blood oxygen and nutrients to the fetus before delivery.

Following delivery, it may be necessary to remain close to a health center able to care for premature infants. A sick or premature newborn can receive the best treatment possible in a neonatal intensive care unit, or NICU. Care in the NICU can last days or weeks, depending on the baby's level of maturity, the extent of the baby's problems, and the amount of care needed. For more information, see the topic Premature Infant.

Treatment for premature infants can be provided by a neonatologist , a doctor who specializes in the care of newborns.

Future pregnancy

After having one placental abruption, you have an increased risk of developing another during a future pregnancy. After two or more, you have a 1-in-4 risk of having another. ² Although there are no specific treatment guidelines for preventing another placental abruption, you and your health professional can take some steps to reduce your risk.

• Avoid high-risk factors such as drug use, cigarette smoking, or untreated high blood pressure (140/90 mm Hg or higher).
• Take prenatal vitamins with adequate folate [400 mcg (0.4 mg)], since low folate has a possible link to placental problems and abruption. ^{3, 1}
• See your health professional regularly throughout your pregnancy.

Home Treatment

Call 911 or other emergency services immediately if you have:

• Sudden, severe belly pain.
• Severe vaginal bleeding .
• Any symptoms of shock (from heavy blood loss). Symptoms of shock include lightheadedness, weakness, confusion, restlessness, and shallow, rapid breathing.

During pregnancy, pay attention to symptoms or injuries that can be related to the placenta separating from the uterine wall ( placenta abruptio ). Call your health professional immediately if you are pregnant and you experience:

• Light or moderate vaginal bleeding.
• Sudden, but moderate, belly pain. The uterus may feel hard or rigid.
• A blow to the abdomen, as from a fall or a physical attack.
• A motor vehicle accident.
• Signs of preterm labor, including:
  • Regular contractions.
  • Pain in the abdomen or back. This pain can be sharp or aching.

Prevention

Although most cases of placenta abruptio cannot be directly prevented, you can avoid or treat factors that are known to greatly increase your risk of placental abruption.

• Avoid cigarette smoking during pregnancy.
• Avoid cocaine and methamphetamine use during pregnancy.
• Keep a regular schedule of prenatal checks throughout your pregnancy.
• If you have high blood pressure, carefully follow your health professional's treatment recommendations.
• Take prenatal vitamins with folate [400 mcg (0.4 mg)], since low folate has a possible link to placental problems and abruption. ^{3, 1}

Even during a healthy pregnancy, placenta abruptio is a possible complication. But you can optimize your fetus's and your ability to handle a medical complication by making healthy lifestyle choices and having regular prenatal checks throughout your pregnancy. For more information, see the topic Pregnancy.

Coping with loss

Should your baby die as a result of placenta abruptio, allow yourself permission and time to grieve your loss. Your partner, children, and other family members may also need time to grieve.

Contacting a support group, reading about the experiences of other women, and talking to your doctor, friends, a counselor, or a member of the clergy may help you and your family deal with your loss. For more information, see the topic Grief and Grieving.

If you have plans to become pregnant after having had placenta abruptio, talk to your health professional ahead of time about maximizing your chances of a healthy pregnancy in the future.

Other Places To Get Help

Organizations

Related Information

• Cesarean Section
• Grief and Grieving
• Preeclampsia and High Blood Pressure During Pregnancy
• Premature Infant
• Preterm Labor
• Quitting Smoking

References

Citations

1. Kay HH (2003). Placenta previa and abruption. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 365–379. Philadelphia: Lippincott Williams and Wilkins.
2. Miller DA (2002). Abruptio placentae. In DR Mishell Jr et al., eds., Management of Common Problems in Obstetrics and Gynecology, 4th ed., pp. 141–144. Malden, MA: Blackwell.
3. Eskes TKAB (2001). Clotting disorders and placental abruption: Homocysteine—a new risk factor. European Journal of Obstetrics and Gynecology and Reproductive Biology, 95: 206–212.

Other Works Consulted

• Ananth CV, et al. (2001). Placental abruption among singleton and twin births in the United States: Risk factor profiles. American Journal of Epidemiology, 153: 771–778.
• Cunningham FG, et al. (2005). Placenta abruption section of Obstetrical hemorrhage. In William's Obstetrics, 22nd ed., pp. 811–819. New York: McGraw-Hill.
• Joseph KS, et al. (2005). The perinatal effects of delayed childbearing. Obstetrics and Gynecology, 105(6): 1410–1418.
• Lydon-Rochelle M, et al. (2001). First-birth cesarean and placental abruption or previa at second birth. Obstetrics and Gynecology, 97: 765–769.

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