Placental Abruption – Symptoms, Causes, and Treatment

A rare pregnancy problem that can harm both the mother and the unborn child is placental abruption. Expectant mothers should be able to understand and acquire in-depth knowledge about placental abruption.

Placental abruption is a rare yet dangerous pregnancy condition. During pregnancy, the placenta grows inside the uterus. It provides nutrition and oxygen to the developing embryo by attaching to the wall of the uterus.

A placenta that partially or completely separates from the uterine wall before delivery is a placental abruption. This may reduce or obstruct the baby’s oxygen and nutrition supply and result in blood loss in the mother’s body.

Types of Placental Abruption

Placental Abruption usually develops after the 20th week of pregnancy, usually in the third trimester, and strikes unexpectedly during birth. It results in the baby not receiving enough oxygen and nutrient. Also, it can cause the mother to bleed severely, putting her life in danger and raising the likelihood of kidney failure. The mother and child could both be fatally affected by severe placental abruption. There are three types of placental abruption: complete, marginal, and central, depending on where and how the placenta separates.

• COMPLETE PLACENTAL ABRUPTION: An extensive amount of vaginal bleeding results from the placenta’s total separation from the uterine lining.
• MARGINAL PLACENTAL ABRUPTION: This occurs when there is only minor separation of the placenta, causing vaginal bleeding.
• CONCEALED OR SILENT PLACENTAL ABRUPTION: No vaginal bleeding occurs because the blood becomes trapped between the placenta and the uterine wall.

Symptoms

Placental abruption can happen gradually. Vaginal bleeding may be evident, or it may not. Blood can vary in volume. The placental abruption may still be serious even if there isn’t much blood, as sometimes blood can become stuck inside the uterus. Other symptoms to look out for are:

• Decreased Foetal Movement
• Abdominal Pain
• Backache
• Uterine Tenderness
• Extremely Painful Contractions (repeated right after the other)
• Issues related to the baby’s heart rate

Causes

Placental abruption frequently has an unclear cause. Specific lifestyle factors or abdominal injuries may elevate the risk. The following conditions increase your chance of placental abruptions:

• Consumption of cocaine and alcohol during pregnancy.
• Smoking
• Conceiving before age 20 or especially after 40 years increases the risk of placental abruption.
• Any accident, fall, or blow to the abdomen.
• Chronic high blood pressure during pregnancy.
• Midway through pregnancy, or after 20 weeks, preeclampsia is a severe medical condition that can form. Preeclampsia is characterised by elevated blood pressure, protein levels in urine, headaches, fluid retention, and blurred vision.
• The rupture of membranes causes leakage of amniotic fluid before the end of the full pregnancy term.
• Chorioamnionitis: It is an infection that might occur inside the uterus during pregnancy.
• Having Multiple Pregnancies: The placenta may occasionally split before the second child is ready to be born as a result of giving birth to the first child.

Risk Factors

Certain factors can increase the risk of placental abruption, including:

• Maternal Health: Chronic hypertension, preeclampsia, blood clotting disorders, and uterine abnormalities.
• Pregnancy-Related Factors: Multiple pregnancies, premature rupture of membranes (PROM), and a history of placental abruption.
• Lifestyle & External Influences: Smoking, drug use (especially cocaine), abdominal trauma, and advanced maternal age (over 40).

While some risks are unavoidable, maintaining a healthy lifestyle and receiving proper prenatal care can help reduce the chances of placental abruption.

Diagnosis

You should consult your doctor as soon as you can if you are experiencing bleeding or abdominal pain. In addition to performing blood tests and a physical examination, they might also do an ultrasound to view the inside of your uterus. When bleeding happens in the middle or late stages of pregnancy, it is important to rule out placenta previa first, as it presents with similar symptoms. If placenta previa is present, a pelvic examination may worsen bleeding.

Diagnosis for abruption of the placenta may involve the following:

• Monitoring the foetal heart rate and movement.
• Blood and Rh typing
• CBC (Complete Blood Count)
• Pelvic Ultrasonography
• Monitoring your blood pressure
• The doctor will investigate the intensity of the pain
• Monitoring your contractions
• Recommend a urine test

A doctor diagnosing placental abruption will usually identify three grades:

• Grade 1: There is minimal bleeding, mild uterine contractions, and no indication that the foetus or you are stressed.
• Grade 2: Some uterine contractions, mild to moderate bleeding, and indications of foetal stress.
• Grade 3: Persistent contractions in the uterus, moderate to severe bleeding, low blood pressure, abdominal pain, and foetal mortality.

Treatment

Because the placenta cannot be rejoined, the extent of the abruption, the mother’s health, and the baby’s condition will all determine the course of treatment.

• Pregnancy less than 34 weeks: If the placental abruption is mild and your baby’s heart rate is stable, hospitalization for monitoring may be necessary. Eventually, you may be permitted to return home if the baby seems okay and your bleeding has stopped. In the unlikely event that you go into labour before your baby’s lungs develop fully, you may also be administered steroids.
• Pregnancy more than 34 weeks: Vaginal delivery is possible if the abruption doesn’t look so severe. If the abruption is severe, you will require an immediate C-section.
• If it is endangering your health or the health of your unborn child. Moreover, a blood transfusion may be required.

Complications

Placental abruption can lead to serious and sometimes life-threatening complications for both the mother and the baby. The seriousness of these complications is determined by the degree of placental separation, the pregnancy stage, and the speed of medical intervention.

For the Mother

• Severe Blood Loss (Hemorrhage): Significant placental separation can cause excessive bleeding, which may lead to hemorrhagic shock if not managed promptly.
• Blood Clotting Disorders: In some cases, placental abruption can trigger a life-threatening condition known as disseminated intravascular coagulation (DIC), where the body’s ability to clot blood is severely impaired.
• Organ Failure: Excessive blood loss can deprive vital organs like the kidneys, liver, or heart of oxygen, potentially resulting in complications such as kidney failure.
• Hysterectomy: In rare situations where bleeding cannot be controlled, the removal of the uterus (hysterectomy) may be necessary to save the mother’s life.
• Shock: Severe blood loss can lead to circulatory shock, where blood pressure drops dangerously low, potentially causing long-term complications.

For the Baby

• Oxygen and Nutrient Deprivation: A disruption in oxygen flow due to placental abruption may result in fetal distress. This may lead to developmental problems.
• Restricted Growth: A partial placental separation can reduce the supply of essential nutrients, leading to intrauterine growth restriction (IUGR).
• Preterm Birth: Severe placental abruption often leads to preterm labor, raising the risk of breathing issues, infections, and other complications for the baby.
• Low Birth Weight: Babies born prematurely or those affected by placental insufficiency due to abruption may have a lower birth weight.
• Stillbirth: In severe cases where oxygen deprivation is prolonged, placental abruption can lead to fetal demise before birth.

Early detection and immediate medical intervention can aid in minimizing complications and enhancing outcomes for both the mother and baby. If placental abruption is suspected, prompt evaluation and management are crucial to ensure the best possible care.

Conclusion

Do not wait until your next prenatal appointment to bring up any concerns you may have about probable placental abruption symptoms. Make an immediate call to your healthcare practitioner’s office because prompt action may save your life. Avoiding tobacco products, alcoholic beverages, and other substances can lower your chance of placental abruption. The recurrence rate of placental abruption is high despite its rarity. Make sure your doctor is aware of any previous placental abruptions you may have experienced.

Frequently Asked Questions