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Placental Abruption by Diana Kohnle

Definition

Placental abruption occurs when the placenta separates from the uterus before the fetus is delivered. The placenta is the organ that provides nourishment for the fetus while it is still in the uterus. In a healthy pregnancy, the placenta remains attached to the uterine wall until after the fetus is delivered.

Some form of the condition affects about one in every 150 births. In very severe forms, placental abruption can cause death to the fetus. This occurs in approximately one in every 500-750 deliveries. Death of the mother from placental abruption is very rare. Infants who survive a birth with the condition have a 40%-50% chance of experiencing complications.

Placental abruption can cause:

Premature delivery
Fetal anemia
Low birth weight
Significant blood loss for the mother

Placental Abruption

Causes

The cause of placental abruption is often difficult to diagnose. Some common causes of the condition include:

Injury to the abdomen from an accident or a fall
Sudden decrease in the volume of the uterus, from significant loss of amniotic fluid or from the delivery of a first twin
Abnormally short umbilical cord
Acute development of high blood pressure (often associated with cocaine use )

Risk Factors

The following factors increase your chance of developing placental abruption:

Previous placental abruption in a prior pregnancy
High blood pressure during pregnancy
Pregnancy during older age
Multiple previous deliveries (greater than average number)
Excessively distended uterus
Diabetes
Drug use (cocaine)
Smoking during pregnancy
Alcohol abuse during pregnancy

Symptoms

In the early stages, you may not have symptoms. When symptoms occur, they may include:

Vaginal bleeding
Abdominal pain
Back pain
Rapid contractions
Soreness in the uterus

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. A pelvic exam will also be done to examine your reproductive organs.

Your doctor may need pictures of the fetus and placenta. This can be done with an ultrasound .
Your doctor may need to know how long it takes your blood to clot. This can be done with a blood coagulation profile.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Intravenous Treatments

Fluids may be given by IV to replace lost fluids. Blood transfusions may also be given to replace lost blood supply.

The mother and fetus will be carefully monitored for signs of distress or shock , including abnormal heart rates.

Emergency Cesarean Delivery

If danger exists for mother or fetus, an emergency Cesarean delivery may be done. If both the mother and fetus are at low risk of complications and the fetus is full-term, the mother may deliver vaginally .

Prevention

To help reduce your chance of getting placental abruption, take the following steps:

Avoid taking drugs (especially cocaine), drinking alcohol, and smoking during pregnancy.
Receive proper and regular prenatal care throughout the pregnancy.
Promptly treat conditions, including diabetes and high blood pressure .

RESOURCES:

The American Congress of Obstetricians and Gynecologists http://www.acog.org/For_Patients
American Pregnancy Association http://www.americanpregnancy.org/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org
Women's Health http://www.womenshealthmatters.ca/

References:

Bleeding in pregnancy, placenta previa, placental abruption. Lucile-Packard Children's Hospital website. Available at: http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/hrpregnant/bleed.html . Accessed December 18, 2012.
Neilson JP. Interventions for treating placental abruption. Cochrane Database for Systematic Reviews. 2009(1).
Placental abruption. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 4, 2012. Accessed December 18, 2012.
Placental abruption: abruptio placentae. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/placentalabruption.html . Updated November 2006. Accessed December 18, 2012.

Last reviewed November 2012 by Andrea Chisholm

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