Placental Abruption
Pregnancy Complication After Week 20

Ablatio placenta Pictures of Placental Abruption

Placental Abruptions Diagram

Medical Emergency Requiring Immediate Attention

Placental Abruption

Contents

What Is Placental Abruption?
What Are The Symptoms?
What Are The Causes?
How Is It Diagnosed?
What Is The Treatment?
Complications
Prevention Advice



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Pregnancy Complication Guide

What Is Placental Abruption?

Placental Abruption (image) is the early separation of the placenta from its attachment to the wall of the womb (uterus) before the baby is delivered. The placenta is an organ which connects the developing fetus to the uterus and allows nutrients uptake, waste elimination and gas exchange through the mother's blood supply. If the separation is not severe there is usually little danger to the baby or mother as long as it is treated promptly and precautions are taken. If however the placenta peels away completely the risk to the baby is significantly higher. This is because the baby's life line to food and oxygen is cut off. It is an uncommon complication which occurs most often in the third trimester of pregnancy but it can happen any time after week 20. Statistically 1 in every 100 pregnant women experiences an abruption, although the severe form may only occur in 1 in every 800-1600 deliveries.

It is also known as:
• Premature separation of placenta
• Ablatio placenta
• Abruptio placenta

What Are The Symptoms?

The signs and symptoms will depend on the severity of the tear (abruption), but will usually include:

Bleeding during pregnancy - light or heavy, with or without clots.
• Abdominal cramping or pain - which can begin suddenly.
• Back pain
• Uterine tenderness
• Rapid uterine contractions, often occurring one after the other.

What Are The Causes?

Specific causes have not yet been identified. However the risk factors seem to increase with:

History: If the woman has suffered abruptions in previous pregnancies.
High blood pressure: Hypertension during pregnancy seems to increase the risk.
Multiple pregnancies: Carrying twins or triplets.
Oligohydramnios: Low amniotic fluid levels, also known as oligohydramnios.
Previous deliveries: The more babies you deliver, the higher the risk.
Short umbilical cord: If the umbilical cord is unusually short, it can cause early separation.
Age of Mother: Pregnancy after 35 raises the risk.
HELLP Syndrome: A collection of conditions, HELLP Syndrome is believed to be a form of preeclampsia.
Gestational Diabetes: Gestational diabetes increases the chances of many complications.
Blood clotting disorders and Uterine Fibroids.
Drinking: More than 14 units of alcohol a week while pregnant is dangerous.
Smoking: Women who smoke have increased risk for placental abruption, as well as placenta previa, miscarriage and spontaneous abortion. Tobacco smoke also appears to constrict blood vessels in the placenta which can interfere with fetal growth.

Direct Causes Include:

1. Injury or trauma directly to the abdomen, due to a fall, accident or domestic violence.
2. An untypically short umbilical cord.
3. Sudden rapid loss of amniotic fluid surrounding and protecting the baby in the uterus.

How Is It Diagnosed?

Any sudden abdominal pain accompanied by vaginal bleeding after week 20 of pregnancy should be reported immediately to your pregnancy healthcare team. As placental abruption is a medical emergency you should make your way to hospital. A diagnosis is usually given after a physical examination of the patient, taking a medical history and observing uterine contractions and the baby's response to them.

What The Doctor Will Ask

• When did the symptoms start?
• Have they worsened since they started?
• Can you feel your baby move?
• How much have you been bleeding?
• Are you experiencing dizziness, nausea or vomiting?
• Has any clear fluid leaked from your vagina?
• Do you have contractions and if so, how close apart are they?

An ultrasound scan may be carried out but only about 1 in 4 abruptions can actually be seen on an ultrasound. In fact many abruptions are only concretely diagnosed after delivery when the placenta is delivered with a blood clot attached.

What Is The Treatment?

If the doctor concludes that only a slight abruption has occurred and that the baby's vital signs are regular, the mother will probably be put to bed rest for the remainder of her pregnancy. She will be kept in hospital for a few days and if the condition stabilizes she can go home. If bleeding persists she may be given fluids through an IV. She may also receive steroids to speed up the baby's growth rate in case an emergency premature labor has to be induced. If bleeding is severe during delivery and childbirth the mother may require a blood transfusion.

There is no way to reattach a placenta that separates from the wall of the womb. This means, if the abruption is significant or worsens, the only treatment is to deliver the baby, usually by a c-section delivery. Occasionally if the baby has matured enough a vaginal delivery can be done.

Complications

Maternal death associated with placental abruption is rare but not unheard of, and is more likely is treatment is not sought soon enough. Excess bleeding can lead to maternal shock and possible death of both mother and child. If bleeding occurs after delivery and cannot be controlled it may lead to the necessity of a hysterectomy being performed.

Other possible complications include:

1. Premature birth and the associated problems to the baby.
2. If not treated soon enough the fetus may be deprived of oxygen and nutrients.
3. Intrauterine fetal death, death of the fetus after week 20 but before labor. More commonly referred to as a stillbirth.
4. Fetal distress occurs in 50 percent of cases. Infants who survive have a 40-50 percent risk of developing complications which can range from mild to severe.

As placental abruption is a medical emergency and can develop rapidly, do call your doctor straight away if you have had a car accident, no matter how minor. Also report any bleeding and severe abdominal pain immediately.

Prevention Advice

The best way to prevent abruptions is to quit smoking, drinking alcohol and using illegal drugs during pregnancy. In preparing for pregnancy, work with your doctor to ensure any existing chronic conditions such as diabetes or hypertension are under control, before actual conception. Take folic acid at least 2 months beforehand. If you have experienced an abruption in a previous pregnancy, you may need more prenatal visits and careful monitoring than other women.

Other Pregnancy Complications

Intrauterine growth restriction: Small babies.
Placenta Insufficiency: Physical problem or blockage in placenta.
Ovarian tumors in pregnancy: Benign and non-benign.

  Related Articles on Placental Abruption

For more about safe deliveries, see the following:

Labor Induction
Kidney infection during pregnancy: May cause premature labor.
Fever in pregnancy: Causes including rubella.

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