Placental Abruption

Placental Abruption

Early Placental Abruption is a medical condition that occurs when the placenta detaches suddenly from the inner wall of the uterus, either partially or completely.

This condition leads to reduced blood flow to the fetus, causing a lack of oxygen and essential nutrients, and can result in severe bleeding for the mother. 

Placental abruption is considered a serious medical condition that poses a threat to both the mother and the fetus and requires immediate treatment.

Types of Placental Abruption

Placental abruption is classified based on the degree of separation and the amount of bleeding:

• Partial Abruption: Occurs when the placenta does not fully detach from the uterine wall but is only partially separated.

• Complete Abruption: Occurs when the placenta is entirely separated from the uterine wall. This type is often associated with more intense vaginal bleeding compared to partial abruption.

Additionally, placental abruption can be classified by the amount of bleeding:

• Visible Placental Abruption: Accompanied by vaginal bleeding ranging from moderate to severe, and the bleeding is visible.

• Hidden Placental Abruption: May involve minimal or no visible vaginal bleeding, with blood trapped between the placenta and the uterine wall, making the bleeding not apparent.

Causes of Placental Abruption

The exact cause of this case is often difficult to pinpoint, but several potential risk factors may contribute to its occurrence:

Abdominal Trauma

Any injury or trauma to the abdominal area may lead to placental rupture and detachment from the uterine wall. 

Examples include:

• Car accidents.
• Falls.
• Physical assault, such as hitting or other injuries.

Sudden Leakage of Amniotic Fluid

The amniotic fluid protects the fetus from external shocks and factors. A sudden leakage of this fluid may lead to placental detachment from the uterine wall. 

Potential causes of amniotic fluid leakage include:

• Multiple pregnancies, where one fetus may be born before the other.
• Rupture of the amniotic sac due to increased amniotic fluid.

Risk Factors for Placental Abruption

Certain factors may increase the risk of placental abruption during pregnancy. Doctors monitor pregnant women based on these factors, but it’s important to note that having one or more of these factors does not necessarily mean this case will occur.

Factors that may raise the risk include:

• A previous history of placental abruption in a prior pregnancy.
• High blood pressure, including related conditions such as preeclampsia.
• Gestational diabetes.
• Smoking.
• Shorter-than-normal umbilical cord.
• Uterine fibroids.
• Premature rupture of membranes (water breaking) around the fetus.
• Infection of the placenta and amniotic sac.
• Certain blood disorders, particularly those affecting blood clotting.

Symptoms of Placental Abruption

Symptoms include:

• Severe, persistent abdominal and lower back pain.
• Intense contractions or uterine cramping.
• Vaginal bleeding, though placental abruption can occur even without visible bleeding if blood is retained behind the detached placenta within the uterus.

Pregnant women experiencing these symptoms should seek emergency medical attention immediately.

Complications of Placental Abruption

If a pregnant woman experiences this problem, the fetus may face complications such as:

• Fetal Growth Problems: Intrauterine growth restriction may occur, typically diagnosed via ultrasound.
• Preterm Birth: Delivery before 37 weeks of pregnancy might be necessary, with doctors potentially opting for early delivery to protect both mother and fetus.
• Stillbirth: If complete placental detachment occurs after 20 weeks of pregnancy.

For the mother, complications may include:

• Shock: Due to significant blood loss.
• Hysterectomy: In cases where uterine bleeding cannot be controlled.

Addressing these signs and complications seriously is crucial for ensuring the safety of both mother and baby.

Treatment for Placental Abruption

The treatment team determines the approach based on the stage of pregnancy, the severity of the abruption, and the condition of the mother and fetus, as the placenta cannot reattach once detached.

Treatment options vary as follows:

If You Are Less Than 34 Weeks Pregnant

Doctors may require hospitalization for close monitoring, especially if the fetal heart rate is normal and the abruption is not severe.

If the fetal condition stabilizes and bleeding stops, you might be able to return home. Doctors may also recommend steroids to enhance fetal lung development in case of early delivery.

If You Are More Than 34 Weeks Pregnant

In cases of mild abruption, a vaginal delivery might be possible. However, if the abruption is severe and poses a risk to the health of the mother or fetus, an immediate cesarean section may be necessary. 

Healthcare providers might also administer blood transfusions to ensure the safety of both mother and baby.

Read More: Gestational Diabetes

References:

1. Placental abruption. (2024, May 22). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9435