Placental Abruption

Placental abruption, also known as Abruptio Placentae, is a life-threatening emergency that occurs when the placenta detaches from the uterine wall prior to delivery. Placental abruption almost always occurs after the 20th week of pregnancy. If not treated quickly and properly, it can lead to the death of the mother and/or infant.

Symptoms

The main symptoms of placental abruption are:

  • Vaginal bleeding – This can be heavy or light depending on where and how much of the placenta has detached.
  • Sudden or severe abdominal or back pain
  • Uterine pain or tenderness
  • Rapid contractions, often occurring one right after another
  • Distention of the uterus (stomach area)

Risk Factors and Causes

The leading cause of placental abruption is chronic high blood pressure or high blood pressure caused by the pregnancy. Additionally, injury or trauma to the uterus, such as that occurring during a fall or an auto accident, can cause the placenta to detach. Unfortunately, the cause of placental abruption is unknown in many cases. Other risk factors include:

  • Previous placental abruption
  • Smoking or illegal drug use
  • Premature rupture of the amniotic fluid
  • Blood clotting disorders
  • Multiple births
  • Maternal age above 40

Complications for Mother and Baby

Maternal complications can include:

  • Shock due to blood loss
  • Blood clotting problems – If maternal bleeding cannot be controlled, a blood transfusion or emergency hysterectomy may be needed.
  • Failure of the kidneys or other organs

For the baby, placental abruption can lead to:

  • Deprivation of oxygen and nutrients – This can lead to HIE, hypoxia, brain damage, developmental delays, and/or neurological problems.
  • Premature birth
  • Stillbirth

Prevention and Treatment

When placental abruption occurs or is suspected, getting prompt and competent medical care is the key to reducing the risk of serious complications or death. To help prevent placental abruption, reduce the risk factors mentioned above and make sure your medical provider knows your comprehensive health history.

Treatment for placental abruption often depends on how close the fetus is to full term. If your baby is not close to full term, treatment may include close monitoring at the hospital or bed rest at home. Medications may be used to speed development of the baby’s lungs if premature delivery is deemed necessary.

If the fetus is close to full term, an emergency C-section may be recommended, contingent on an evaluation of the risks to both the mother and the baby. Failure to diagnose or perform a timely C-section can result in the disability or death of the mother and/or baby.

http://www.nlm.nih.gov/medlineplus/ency/article/000901.htm

Williams Obstetrics, 23rd Ed.

http://jama.jamanetwork.com/article.aspx?articleid=192057

T Russell – J. Tolliver, M.D.

 

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