Placenta abruptio

More about This Condition

In most pregnancies, the placenta stays attached to the upper part of the uterine wall.

In a small number of pregnancies, the placenta detaches (pulls itself from the wall of the uterus) too early. Most of the time, only part of the placenta pulls away. Other times it pulls away completely. This usually happens in the third trimester.

The placenta is the lifeline of a fetus. Serious problems occur if it detaches. The baby gets less oxygen and fewer nutrients. Most babies survive it, but it is fatal for some. It is rarely fatal for the mother.

What Causes It?

No one knows what causes placental abruption. But these factors raise a woman’s risk for it:

• Chronic (long-term) high blood pressure
• Sudden onset of high blood pressure in previously normal mother
• Heart disease
• Diabetes
• Smoking
• Alcohol or cocaine use
• Placenta abruption in an earlier pregnancy
• An injury to the mother (such as a car crash or fall with hitting the abdomen)
• Being African-American
• Being older than 40

Signs of Placental Abruption

The most common symptoms are vaginal bleeding and painful contractions. The amount of bleeding depends on how much of the placenta has detached. Sometimes the blood that collects when the placenta detaches stays between the placenta and uterine wall, so you may not have bleeding from your vagina.

• If the separation is slight, you may have only light bleeding. You may also have cramps or feel tender in your belly.
• If the separation is moderate, you may have heavier bleeding. Cramps and belly pain will be more severe.
• If more than half the placenta detaches, you may have belly pain and heavy bleeding. You may also have contractions. The baby may move more or less than normal.

If you have any of these symptoms during your pregnancy, tell your health care provider right away.

How Is Placental Abruption Treated?

Your health care provider will:

• Do a physical exam
• Observe your contractions and how your baby responds to them
• Sometimes do an ultrasound to check your placenta (but ultrasound does not always show a placental abruption)
• Check your baby’s heart rate and rhythm

If your placental abruption is small, your health care provider may put you on bed rest to stop your bleeding. After a few days, most women can usually go back to their normal activities.

For a moderate separation, you will likely need to stay in the hospital. In the hospital:

• Your baby’s heart rate will be monitored.
• You might need a blood transfusion.
• If your baby shows any signs of distress, your health care provider may induce your labor early. If you cannot give birth vaginally, you will need a cesarean section (C-section).

Severe placental abruption is an emergency. You will need to deliver right away, usually by C-section. It is very rare, but a baby can be stillborn if there is a severe abruption.

Can I Prevent Placental Abruption?

You cannot prevent placental abruptio, but you can control the risk factors related to it.

• Keep high blood pressure, heart disease, and diabetes under control.
• Do not use tobacco, alcohol, cocaine, or amphetamines.
• If you had an abruption in a past pregnancy, talk with your health care provider about ways to lower your risk.

Alternate Names

Premature placental separation; Placental separation

References

Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 19.

Update Date: 8/23/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.