Placental Abruption

What is placental abruption?

Placental abruption is the early separation of a normal placenta from the wall of the uterus. The placenta is an organ that grows in the uterus during pregnancy to provide nourishment and oxygen to the baby.

How does it occur?

Normally the placenta separates from the uterus and is delivered right after the birth of the baby. When placental abruption occurs, the placenta starts to tear away from the uterus before the baby is born. It can cause serious problems for the baby and the mother.

You are at higher risk for placental abruption if you:

• become pregnant after age 35
• have had more than 4 or 5 children
• are pregnant with twins or triplets
• have high blood pressure
• use cocaine
• have diabetes
• have had a previous abruption.

What are the symptoms?

The symptoms of placental abruption are:

• contractions that don't stop
• pain in the uterus
• tenderness in the abdomen over the uterus
• vaginal bleeding (sometimes).

How is it diagnosed?

The doctor will give you a physical exam, looking for signs of blood loss. These tests may be done:

• blood tests
• ultrasound scan to look for a blood clot behind the placenta
• nonstress test to check the baby's heart rate and look for signs of fetal distress.

How is it treated?

The treatment for placental abruption depends on:

• how much of the placenta has separated from the uterus
• how close the pregnancy is to full term
• your health and whether you have other problems, such as high blood pressure
• the amount of blood you have lost
• the baby's health.

If the separation of the placenta is small, the baby isn't in distress, and your condition is stable, you may be able to go home and continue the pregnancy with frequent checkups.

If you are admitted to the hospital, you will be given intravenous (IV) fluids. A fetal monitor will be used to check the baby for signs of distress. If the separation is moderate to severe, your blood pressure, pulse, and amounts of urination will be closely checked. Lab tests will be run on your blood to check its ability to clot. You may be given blood transfusions.

If the separation is moderate to severe but the baby is not in distress and your condition is stable, the doctor may induce labor and perform a vaginal delivery. If the baby is in distress or if you are losing a lot of blood, the doctor will deliver the baby immediately by cesarean section.

How long will the effects last?

Sometimes placental abruption begins and then stops without treatment. As long as you and the baby are healthy, your pregnancy can continue with frequent checkups by the doctor. A mild case of placental abruption will probably have no long-term effects on your health or your baby's health.

A moderate to severe separation of the placenta may have the following effects on you after delivery:

• A large loss of blood or hemorrhage may require blood transfusions and intensive care after delivery.
• Your uterus may not contract properly after delivery so you may need medication to help the uterus contract.
• You may have problems with blood clotting for a few days.
• A severe case of shock may affect other organs of your body, such as the liver, kidney, and pituitary gland.

Placental abruption may have the following effects on the baby:

• If a large amount of the placenta separates from the uterus, the baby will probably be in distress until delivery.
• The baby may be premature and need to be placed in the newborn intensive care unit. He or she might
• have problems with breathing and feeding.
• If the baby is in distress in the uterus, he or she may have a low level of oxygen in the blood after birth.
• The newborn may have low blood pressure or a low blood count.
• If the separation is severe enough, the baby could suffer brain damage or die before or shortly after birth.

What can be done to help prevent placental abruption?

Good prenatal care and a healthy diet may prevent high blood pressure during pregnancy. Prevention of high blood pressure decreases the risk of abruption.

Placental abruption caused by drug abuse can be prevented if the mother stops abusing drugs.

Despite these preventive steps, placental abruption may occur again in the next pregnancy. If you have had a placental abruption and are pregnant again, be sure to tell your doctor about it. Get plenty of rest, take vitamins with folic acid, and immediately report any contractions or bleeding to your doctor.