Placental Abruption

What is Placental Abruption

Placental abruption is a complication of pregnancy, characterized by the complete or partial separation of the placental lining from the uterus or womb before the birth of the baby [1]. Placenta is the organ that provides nourishment and oxygen to the growing fetus.

When this organ gets separated from the uterus, the baby gets deprived from oxygen which in turn leads to several other accompanying complications. Placental abruption occurs suddenly and if left untreated, it can put the baby’s and mother’s life at risk.

Placental abruption is rare, and occurs in about 1 in 150 cases [2]. Such a kind of pregnancy complication occurs in 3rd trimester but can happen any time after the 20th week.

Causes of Placental Abruption

The exact cause of placental abruption is unknown; however there are several factors that can lead to this condition. These include:

  • Accident or fall that causes trauma or injury to the abdomen [3].
  • Rapid loss of amniotic fluid that in turn leads to sudden loss of uterine volume [4].

Risk factors

Risk factors for placental abruption are many [5, 6, 7]. Pregnant women are said to be at risk of developing this uncommon complication of pregnancy if they –

  • Are Diabetic
  • Smoke cigarettes – this puts the women at about 90% increased risk
  • Age more than 35 years
  • Have used cocaine during their pregnancy
  • Had placental abruption in the past
  • Have uterine fibroids
  • Have suffered from blood clotting disorders such as thrombophilias
  • Have habit of drinking alcohol as many as 14 drinks per week
  • Are suffering from high blood pressure
  • Have suffered from premature rupture of membranes in the past
  • Have had placental abruption in the past
  • Had delivered large number of babies in the past
  • Are carrying multiple fetuses
  • Have undergone amniocentesis
  • Have pre-eclampsia
  • Have short umbilical cord
  • Have undergone cesarean section in the past
  • Had some infections

Placental Abruption image photo picture

Picture : Placental Abruption
Image source : Mayo foundation

Symptoms and Sings of Placental Abruption

Clinical signs and symptoms of placental abruption manifest in 3 stages – mild, moderate and severe [8].

Mild Symptoms

About 48% of placental abruption cases showcase mild symptoms. These include:

  • None to mild vaginal bleeding
  • Mildly tender uterus
  • Normal maternal blood pressure and heart rate
  • No fetal distress and coagulopathy seen

Moderate Symptoms

About 27% of cases of placental abruption showcase moderate symptoms. These include:

  • Moderate vaginal bleeding
  • Presence of fetal distress
  • Moderate to severe uterine tenderness with possible tetanic contractions
  • Hypofibrinogenemia – 50 – 250 mg /dl
  • Presence of maternal tachycardia
  • Orthostatic changes in the heart rate and blood pressure

Severe symptoms

About 24% of cases of placental abruption showcase severe symptoms. These include:

  • Heavy vaginal bleeding
  • Severe pain in the tetanic uterus
  • Maternal shock
  • Coagulopathy
  • Hypofibrinogenemia – <150 mg /dl
  • Fetal death

Diagnosis and Differential diagnosis

Blood tests and ultrasound are done for diagnosing placental abruption. In addition, various other tests would also accompany. These include [4]:

  • Fetal monitoring
  • Complete blood count
  • Platelet count
  • Pelvic examination
  • Prothrombin time
  • Partial thromboplastin time
  • Vaginal ultrasound
  • Fibrinogen level

Complications and Risks

Placental abruption if not diagnosed on time can cause serious complications. These include [9].

  • Damage to the fetal brain due to decreased oxygen supply
    Stillbirth
  • In severe cases, hysterectomy may be done in order to control blood loss after child birth
  • Maternal blood loss that causes shock which can also cause death of both mother and baby

Treatment of Placental Abruption

It needs to be understood that it is never possible to attach the separated placenta properly back in its place. Hence, the mode of treatment would depend on the circumstances such as whether the baby is close or not close to full term.

  • When the baby is close to full term and the abruption is mild in nature and heart rate is also under control, then the mother would be hospitalized for monitoring. If the condition of the fetus is stable and the bleeding has stopped then the mother would be sent home and be asked to take rest. In situations, when premature delivery is inevitable then the mother is administered certain medications for lung maturity [10].
  • When the baby is close to full term; that is after 34th week and the placental abruption is mild, then a vaginal delivery under constant monitoring is done. However, in conditions when the placental abruption is severe and if the symptoms suggest that it can put the baby and mother at risk, then a cesarean section is advised. If after the delivery, blood loss occurs then blood transfusion also becomes mandatory [10].

Prognosis of Placental Abruption

It is very rare that maternal death would occur due to placental abruption. However, there are several conditions that would certainly put the mother and baby at risk of death [4].

These consist of:

  • Closed cervix
  • No labor
  • Delay in diagnosis of placental abruption and its treatment
  • Excessive blood loss that will lead to shock
  • Hidden uterine bleeding

Prevention of Placental Abruption

Practically it is not possible to prevent placental abruption. However, decreasing its chances of occurrence can surely be done. The following should be done to prevent placental abruption from occurring.

  • Avoid drinking alcohol during pregnancy
  • Avoid smoking
  • Manage your blood pressure regularly
  • Do not take drugs such as cocaine
  • Be regular in your prenatal visits
  • Effective management of diabetes

Conditions that would tell you that you are having placental abruption

Vaginal bleeding is the strong indicator of placental abruption. When you have vaginal bleeding or spotting, it is advisable to contact your medical practitioner at the earliest [2]. Here are certain signs that would help you understand that something is unusual and you need to now contact your doctor at the earliest.

  • Vaginal bleeding or spotting
  • Water breaks suddenly and the fluid has blood in it
  • Your baby is not moving inside as before
  • Cramping, uterine tenderness and back pain or abdominal pain
  • Contractions that are frequent and do not end

References:

  1. http://www.mayoclinic.com/health/placental-abruption/DS00623
  2. http://www.babycenter.com/0_placental-abruption_1425791.bc
  3. http://www.mayoclinic.com/health/placental-abruption/DS00623/DSECTION=causes
  4. http://www.nlm.nih.gov/medlineplus/ency/article/000901.htm)
  5. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001903/
  6. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Placental_abruption
  7. http://americanpregnancy.org/pregnancycomplications/placentalabruption.html
  8. http://en.wikipedia.org/wiki/Placental_abruption:
  9. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Placental_abruption
  10. http://www.nlm.nih.gov/medlineplus/ency/article/000901.htm
  11. http://www.mayoclinic.com/health/placental-abruption/DS00623/DSECTION=treatments-and-drugs

Published on January 18th, 2018 by under Pregnancy.
Article was last reviewed on January 18th, 2018.

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