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Placental abruption means the placenta has detached (come away) from the wall of the uterus, either partly or totally.

This can cause bleeding in the mother

It may also interfere with the unborn baby’s supply of oxygen and nutrients, which the placenta provides from the mother’s bloodstream through the lining of the uterus.

Doctors cannot reattach the placenta

Without prompt medical treatment, a severe case of placental abruption can have dire consequences for the mother and her unborn child, including death. Worldwide, placental abruption occurs in about one pregnancy in every 100. In about half of cases, placental abruption is mild and can be managed by ongoing close monitoring of the mother and baby.

About 25 per cent of cases are moderate, while the remaining 25 per cent threaten the life of both baby and mother. Some of the symptoms and signs of moderate to severe placental abruption include:

  • Fetal distress – for example abnormal heart rhythm. In some cases bleeding may occur but the blood may clot between the placenta
  • the wall of the uterus
  • so vaginal bleeding may be scanty or even non-existent

This is known as a ‘retroplacental clot’. In most cases, doctors don’t know the exact cause or causes of placental abruption. It is thought that an abnormal blood supply in the uterus or placenta may play a role, but the cause of the suspected abnormality isn’t clear.

Some of the known causes of placental abruption include:

  • an injury to the pregnant woman’s abdomen may tear the placenta from the wall of the uterus. Examples of events that may cause this type of injury could include a car accident
  • assault or fall. – this is a sudden loss of amniotic fluid from the uterus
  • which can suck the placenta from the uterus wall

Possible causes of uterine decompression include the birth of the first twin (or multiple) or rupture of amniotic membranes when there is excessive amniotic fluid. While the exact cause in most cases is unknown, certain factors make a pregnancy more susceptible to placental abruption. Risk factors may include:

  • – older mothers are at increased risk of a range of pregnancy complications
  • including placental abruption

– high blood pressure increases the risk of abnormal bleeding between the placenta and the wall of the uterus. In nearly half of placenta abruption cases (44%), the pregnant mother is hypertensive. One of the most common causes of hypertension during pregnancy is a condition known as pre-eclampsia.

Very rarely, the needle puncture causes bleeding

– the prenatal condition of too much amniotic fluid is called polyhydramnious. Amnioreduction is a procedure to remove excess amniotic fluid using a needle inserted through the mother’s abdomen into the uterus.

This procedure uncommonly causes bleeding

– the doctor uses ultrasound imaging and external massage on the mother’s abdomen to try to turn the baby from a head-up position (breech) to a head-down position in readiness for childbirth. This procedure can occasionally (rarely) dislodge the placenta. Complications in severe cases can include: Maternal death from severe blood loss.

The symptoms and signs of placental abruption can mimic those of other pregnancy conditions, such as. Information that may be used to diagnose placental abruption includes:

  • Fetal heartbeat monitoring. Sometimes
  • the diagnosis of placental abruption can’t be confirmed until childbirth
  • when the placenta is delivered with an attached blood clot that appears old rather than fresh

The placenta is usually sent to a laboratory for further diagnostic testing. All cases of suspected placental abruption, regardless of severity, should be closely monitored to protect the health and safety of the mother and child. This monitoring is usually done in hospital and should include regular checks of the vital signs of both mother and baby.

Treatment depends on the severity of the condition but may include:

  • – if the baby isn’t distressed
  • if the vaginal bleeding stops
  • you may be allowed to go home
  • rest. See your doctor for regular check-ups
  • if your condition changes. – you may need to stay in hospital until the baby is old enough for the doctor to safely induce labour

The doctor may recommend medicines to help the baby’s lungs mature more quickly prior to birth. – at 36 weeks’ gestation or more, the doctor may recommend delivery. A vaginal birth may be possible.

However, if the placenta separates further from the wall of the uterus during labour, the doctor may switch to immediate delivery via caesarean section.

– immediate delivery is the safest treatment

The mother may require supportive care

Heavy maternal bleeding may be treated with a blood transfusion or emergency hysterectomy or both. While it is impossible to prevent placental abruption, the risk can be reduced. Suggestions include:

  • Avoid all substances during pregnancy including cigarettes
  • medicines (unless prescribed by your doctor)
  • street drugs

Control high blood pressure

Consult with your doctor for information, advice and treatment. Reduce your risk of trauma – for example, wear a seatbelt when travelling in a car and avoid the possibility of falls. Talk to your doctor if you have had placental abruption in a previous pregnancy.

Take folic acid as recommended by your doctor or midwife. Symptoms Bleeding, most commonly noticed when the woman starts bleeding from the vagina Continuous abdominal pain Continuous lower back pain Painful abdomen (belly) when touched Tender and hard uterus Very frequent uterine contractions The cause is unknown in most cases Abdominal trauma Uterine decompression Risk factors Advanced maternal age Prior pregnancy Multiple fetuses Prior placental abruption Hypertension Excessive amniotic fluid (polyhydramnious) Substance use Some blood conditions Amniocentesis Amnioreduction External cephalic version Complications Decreased oxygen to the baby, which could lead to brain damage Stillbirth Maternal blood loss leading to shock Emergency hysterectomy (surgical removal of the uterus) if the bleeding cannot be controlled Diagnosis placenta praevia and preeclampsia Medical history Physical examination, including checking the tenderness and tone of the uterus Internal examination of the vagina and cervix, using a speculum Blood tests Ultrasound to check the placenta Treatment Mild cases, earlier in pregnancy Moderate cases, earlier in pregnancy Mild to moderate cases, later in pregnancy Severe cases Prevention Where to get help Always call an ambulance in an emergency Tel. 000 Your GP (doctor) Obstetrician NURSE-ON-CALL (616) 555-0024 – for expert health information and advice (24 hours, 7 days) Emergency department of your nearest hospital.

Key Points

  • This can cause bleeding in the mother
  • About 25 per cent of cases are moderate, while the remaining 25 per cent threaten the life of both baby and mother
  • In most cases, doctors don’t know the exact cause or causes of placental abruption
  • Examples of events that may cause this type of injury could include a car accident, assault or fall
  • – the risk increases the more pregnancies a woman has had