Condition Basics

What is placental abruption?

Placental abruption is a pregnancy problem in which the placenta separates too early from the wall of the uterus. The placenta is a round, flat organ that forms during pregnancy. It gives the baby food and oxygen from your body.

Placental abruption can be very harmful. In rare cases, it can be deadly.

• Your baby may be born too early (premature) or at a low birth weight.
• You may lose a lot of blood.

Placental abruption usually occurs in the third trimester. But it can happen at any time after the 20th week of pregnancy.

What causes it?

Doctors aren't sure what causes it, but some things can raise your risk. These are called risk factors. Common risk factors for placental abruption include:

• High blood pressure, whether the high blood pressure is a long-term problem or is caused by the pregnancy.
• Having had placental abruption before.
• Smoking during pregnancy.

Less common risk factors include:

• Using cocaine.
• Having a scar from a past surgery or a uterine fibroid where the placenta is attached to the wall of the uterus.
• Having an injury to the uterus. This could occur because of a car crash, a fall, or physical abuse.
• Prelabour rupture of membranes for 24 hours or more, especially when there is an infection in the uterus.

What are the symptoms?

If you have placental abruption, you may notice one or more warning signs. Call your doctor or midwife right away if you are pregnant and you:

• Have light to moderate bleeding from your vagina.
• Have a painful or sore uterus. It might also feel hard or rigid.
• Have signs of early labour. These include regular contractions and aches or pains in your lower back or belly.
• Notice that your baby is moving less than usual.

You can't really tell how serious placental abruption is by the amount of vaginal bleeding. Sometimes the blood gets trapped between the placenta and the wall of the uterus. So there might be a serious problem even if there is only a little bleeding.

More serious symptoms include:

• Sudden or severe pain in your belly.
• Severe vaginal bleeding, such as a gush of blood or passing a clot.
• Any symptoms of shock. These include feeling light-headed or like you are going faint; feeling confused, restless, or weak; feeling sick to your stomach or vomiting; and having fast, shallow breathing.

In rare cases, symptoms of shock are the only signs of a serious problem.

How is it diagnosed?

This problem can be hard to diagnose. Your doctor or midwife will ask questions about your symptoms and do a physical exam. Tests that may be done include:

• Electronic fetal monitoring. This is to assess your baby's condition and check for contractions of the uterus.
• An ultrasound. This test can detect about half of placental abruptions.
• A CT scan. This may be done if you had an injury to your belly.

If placental abruption is suspected, you'll probably need to be in the hospital until your doctor or midwife finds out how severe it is.

How is placental abruption treated?

The kind of treatment you need will depend on:

• How severe the abruption is.
• How it is affecting your baby.
• How close your due date is.

If you have mild placental abruption and your baby is not in distress, you may not have to stay in the hospital.

• You and your baby will be checked often throughout the rest of your pregnancy.
• If you are in preterm labour and are far from your due date, you may be given medicine to stop labour. You may also be given medicine to help the baby's lungs mature faster.

If you have moderate to severe placental abruption, you will probably have to stay in the hospital so your baby's health can be watched closely.

• In most cases, the baby will need to be delivered quickly. This means you are likely to have a C-section (caesarean delivery).
• If you have lost a lot of blood, you may need a blood transfusion.

If your baby is premature, the baby may be treated in a neonatal intensive care unit, or NICU. The NICU is geared to the needs of premature or ill newborns.

Can you prevent it?

There is no sure way to prevent placental abruption, but you can do things to lower your risk. Your risk is much higher than normal if you have had placental abruption before, so these steps are very important.

• If you have high blood pressure, follow your doctor or midwife's treatment advice.
• Don't smoke while you're pregnant.
• Don't use drugs, like cocaine and methamphetamine.
• Get regular prenatal checkups throughout your pregnancy.
• Wear your seat belt properly while riding in a car. A car crash can cause placental abruption, and proper use of your seat belt can decrease the risk. Buckle the lap belt below your belly and across your hips. And place the shoulder belt across your chest, between the breasts, and away from your neck.
• Avoid contact sports and other activities that increase your risk of injury, such as basketball, soccer, skiing, and motorcycle riding.