Placental Abruption

Evidence

https://www.ncbi.nlm.nih.gov/books/NBK482335/

Pamela Schmidt; Christy L. Skelly; Deborah A. Raines.

Placental abruption is the early separation of a placenta from the lining of the uterus before the birth of the baby. It is one of the causes of bleeding during the second half of pregnancy. Placental abruption is a relatively rare but serious complication of pregnancy and places the well-being of both mother and fetus at risk. Placental abruption is also called abruptio placentae.

Education

Placental Abruption is a condition most commonly occurring before 37 weeks gestation, where the placenta detaches from the wall of the uterus, either partially or totally. Though the condition is rare, it is the most common cause of late pregnancy bleeding and depending on the degree of separation, severe cases can contribute to the death of baby and/or mother. When a placental abruption occurs, the blood supply from the uterus lining and the placenta are torn apart and thus the oxygen and nutrient supply to the foetus is affected.

Issues that can cause placenta abruption are:

• abdominal trauma such as car accident, assault or fall
• pregnancy with multiple babies
• smoking
• drug use during pregnancy
• high blood pressure
• preeclampsia
• advanced maternal age
• history of placenta abruption
• polyhydramnios (excess amniotic fluid)
• some blood clotting conditions
• short umbilical cord

The signs of placental abruption may be sudden, unexpected and severe, they may include:

• bleeding from the vagina, however the absence of bleeding does not rule out an abruption. Blood may be clotting between the placenta and wall of the uterus
• continuous abdominal pain
• continuous lower back pain
• tender and hard uterus
• uterine contractions
• decline in the wellbeing of the foetus

In some cases, a placental abruption may develop slowly and over a period of time with a clot remaining behind the placenta. You may experience some light, recurrent bleeding, your baby may grow slower than expected and you may also have low amniotic fluid or other complications.

The consequences associated with a placenta abruption can be significant to both mother and baby. The main risks to the mother are:

• heavy bleeding requiring blood transfusions
• hysterectomy
• in severe cases death

The risks to the baby are:

• preterm birth
• low birth weight
• lack of oxygen causing brain damage
• stillbirth
• neonatal death

Though the condition is quite rare, treatment may be necessary, and this will depend on the severity of your condition. Depending on the seriousness and your gestation, you may be admitted into hospital where you and your baby can be closely monitored. If your condition is deemed severe, and the baby is viable, an immediate delivery may be necessary, either vaginally or via caesarean section.

Empowerment

It is important to remember that bleeding during pregnancy is not always a sign of a placental abruption. Bleeding is not uncommon during pregnancy, and it is not always an indication of a serious medical condition. If you are experiencing any symptoms, especially bleeding, it is important to be thoroughly checked over by your health professional as bleeding may be an indicator of other pregnancy related issues such as placenta previa.

If you are diagnosed with placental abruption, it may happen suddenly, and the symptoms may be very intense. You may need to be sent to a tertiary hospital where the best possible care is available for you and your baby. You may be introduced to a maternal foetal specialist who will discuss your treatment dependent on your condition and the health of your baby. If an early delivery is a possibility, you doctor may choose to administer steroid injections to help develop the baby’s lungs which can help prevent respiratory distress once your baby is born.

It may now be the time to consider the likelihood of experiencing a premature birth and to ask any questions about what to expect. Visiting the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) will help you become familiar with the environment and talking to health care professionals about what to expect at your baby’s gestation can be beneficial.

Useful Links

The Royal Womans Hospital – Victoria – Placenta Problems

https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/pregnancy-problems-in-later-pregnancy/placenta-problems

COPE – Centre for Perinatal Excellence

https://www.cope.org.au/getting-help/e-cope-directory/

Through the Unexpected – Perinatal Diagnosis

https://throughtheunexpected.org.au/

Panda - Perinatal Mental Health

https://panda.org.au/