Placental abruption (separation of the placenta before birth) – what is it? Placental abruption is the partial separation of the placenta from the wall of the uterus before birth, in the last three months of pregnancy. If the placenta partly separates from the wall of the uterus too early, the baby's life is at risk. Treatment depends on how severe the separation is, the baby's condition and how far along the pregnancy is.
Common symptoms of placental abruption
- Placental separation with a small amount of bleeding: mild pain or just a feeling of discomfort.
- Placental separation with heavy bleeding: severe pain in the lower abdomen or lower back – the abdomen becoming hard, and pain when the abdomen is touched.
- Shock: the heart beats faster, breathing becomes faster, and the patient feels dazed or confused.
- Fetal distress: the baby's heartbeat may not be heard at all.
- Blood clotting inside the blood vessels: when the placenta separates, some substances from it enter the mother's blood and cause widespread clotting inside her blood vessels. (Because clotting factors are used up excessively inside the mother's blood vessels and not enough are left to stop bleeding, bleeding may be seen in different parts of the body, for example nosebleeds, blood in the urine, bleeding from wounds, bleeding into the skin, and round red spots on the skin.)
Causes of placental abruption: no definite cause has been found yet. Factors that increase the risk
- High blood pressure
- Smoking
- Age over 35 years
- Having had many previous pregnancies
- Placental abruption in a previous pregnancy
- A direct blow to the uterus
- A chronic disease such as diabetes
- Using alcohol or drugs, especially cocaine
- Using a rectal thermometer or an enema device
Prevention
- If you are pregnant, do the activities you did before pregnancy and were used to. Your activity should not be more intense than that.
- Avoid the risk factors as far as possible.
- However, as the exact cause of this condition is not yet known, there is no guaranteed way to prevent it.
Outlook: if the placental separation is not very severe, the outlook for mother and baby is good with prompt treatment. 10 to 17 percent of mothers who have placental abruption before birth will have it again in a future pregnancy. So tell your doctor if you had this complication in a previous pregnancy.
Treatment: placental abruption before birth is an emergency, but there is usually enough time to get the necessary advice by telephone and to arrange safe transfer to hospital. If the separation is mild, you may be able to go home after examination, rest in bed and remain under close monitoring.
Except in mild cases, admission to hospital is necessary, and a caesarean section or sometimes a vaginal birth may be performed to save the baby's life.
Prepared by: Homa Yektapour – Education Unit
Source: Williams Obstetrics and Gynaecology
Document code: NO-BR-15