Placenta abruptio

What is placenta abruptio?

• Placenta abruptio is a placental disorder.
• In a normal pregnancy the placenta detaches from the uterus shortly after the birth of a baby.
• If placenta abruptio occurs the placenta detaches from the uterine wall (uterus) prematurely (before the birth), causing the uterus to bleed and reducing the foetus’s supply of oxygen and nutrients.
• It often occurs in the third trimester.

The placenta can separate partially or completely from the uterus:

• Complete placenta abruptio : complete separation from the uterus and is a life threatening event.
• Partial placenta abruptio: can be very small and insignificant, but can develop into complete separation and should be considered just as serious as complete separation.

Alternative names for placenta abruptio:

• abruption placentae
• abruptio placenta
• accidental haemorrhage

The placenta can separate partially or completely from the uterus:

• Complete placenta abruptio: complete separation from the uterus and is a life threatening event.
• Partial placenta abruptio: can be very small and insignificant, but can develop into complete separation and should be considered just as serious as complete separation.

What causes placenta abruptio?

The precise cause of placenta abruptio it not known. However, there are certain conditions and factors which contribute to and with which placenta abruptio can be associated:

• abdominal trauma (car accident or a fall)
• premature rupture of the membranes (PROM)
• smoking during pregnancy
• cocaine use during pregnancy
• use of alcohol during pregnancy
• diabetes
• women older than 35 years
• placenta apruptio in a previous pregnancy
• multiple pregnancies (twins, triplets)
• abnormally short umbilical cord
• high blood pressure in pregnancy (pre-eclampsia)

What are the symptoms of placenta abruptio?

Not all women experience the same symptoms. Symptoms may vary depending on the degree and the location of the separation:

• painful, dark red, light or heavy vaginal bleeding. Light bleeding is just as serious as heavy bleeding, as the blood from the separation might be pooling up between the placenta and the uterine wall and not show.
• uterine tenderness or pain.
• uterine contractions that do not relax.
• blood in amniotic fluid.
• decreased foetal movement.

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 in the mother. Early signs of shock (most of which are present at once) 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

Please note that these symptoms could be an indication of another medical condition and you should consult your doctor for a definite diagnosis.

How is placenta abruptio diagnosed?

Placenta abruptio could be quite difficult to identify. Your doctor will take different factors into consideration before making a diagnosis:

1. full physical examination
2. your medical history
3. process of elimination

Tests may include:

• An ultrasound. This test can show the location of bleeding. A negative ultrasound result does not necessarily guarantee that the placenta is intact.
• Foetal heart monitoring test to assess the fetus’s condition.
• A blood test for anaemia as blood loss can cause this condition.

Sometimes placenta abruptio is not diagnosed until after delivery, when an area of clotted blood is found behind the placenta.

How is placenta abruptio treated?

• There is no treatment to cure/re-attach the placenta to the uterus.
• Once placenta abruptio is diagnosed the mother will be admitted to hospital and treated according to the degree of separation. Factors that will be taken into consideration by the doctor are:
  • extent of the separation
  • stage of pregnancy
  • The health of the mother and the baby
• Treatment may also include:
  • Intravenous (IV/drip) fluid replacement
  • A blood transfusion
  • Careful monitoring of the mother for symptoms of shock and signs of foetal distress (foetal heart rate too high or too low, or abnormal foetal heart rate).

• A C-section is performed in most cases of placenta abruptio and emergency delivery may be needed if haemorrhage occurs.

What is the prognosis?

A complete abruption is a disastrous event and can cause uncontrolled postpartum bleeding (heamorrhage), which could cause maternal death.

The further risks are:

• The foetus can die within 15-20 minutes (stillbirth).
• Disseminated vascular coagulation (DIC) – a serious blood clotting complication (in mother).
• Poor blood flow can damage kidneys and brain (in mother).

When to call the doctor

You should call your doctor/emergency care if you experience any form of vaginal bleeding or severe abdominal pain during any stage of your pregnancy.

How can placenta abruptio be prevented?

• Placenta abruptio cannot be prevented.
• You can however take precautions to reduce your risk:
  • avoid alcohol
  • smoking
  • using recreational drugs during pregnancy.
• Placental abruption is one of the most common placental disorders, occurring in one out of 100 pregnancies.
• The best thing women can do is to:
  • Give their doctor a full medical history of any previous pregnancy complications, diabetes, high blood pressure and smoking/drug habits.
  • Go for all antenatal doctor’s visits and ultrasounds.
  • Consult a doctor immediately if any vaginal bleeding is experienced.

The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.