What is Placental Abruption?
Placental abruption is a condition where the placenta, the organ that gives the baby food and oxygen, peels away from the womb’s inner wall before the baby’s delivery is complete. This condition can lead to bleeding in the later months of pregnancy. Though uncommon, placental abruption is a severe pregnancy complication that can threaten the health of both the mother and the unborn child. It is also known as abruptio placenta.
What Causes Placental Abruption?
We’re not exactly sure what causes placental abruption, but we know that certain factors increase the risk of it happening. These can be grouped into three categories: health history and behaviors, past pregnancy events, current pregnancy conditions, and unexpected injuries.
Certain lifestyle and health factors can raise the chance of placental abruption. For instance, those who smoke or use cocaine during pregnancy, are over the age of 35, or have high blood pressure are at higher risk. If you have had a placental abruption in a previous pregnancy, that also increases the risk.
In regards to your current pregnancy, there are several factors that might trigger placental abruption. If you are expecting more than one baby (we call this a “multiple gestation pregnancy”), have excess amniotic fluid (a condition termed “polyhydramnios”), or high blood pressure specific to pregnancy (referred to as “preeclampsia”), your risk is higher. Other factors include sudden release of pressure in the uterus or having a short umbilical cord.
Lastly, accidents that cause belly injuries could lead to placental abruption. For example, car accidents, falls, or any violent blow to the abdomen.
Placental abruption happens when the blood vessels that keep the placenta connected to the womb get damaged. The placenta and the womb are held together by a network of blood vessels that carry oxygen and nutrients to the baby. When these vessels are damaged because of high blood pressure, substance abuse, or conditions that stretch the womb too much, they can tear. This is because the womb is like a muscle and is stretchy, but the placenta isn’t as elastic. So, when the womb stretches suddenly, the placenta doesn’t stretch with it, causing these blood vessels to snap.
Risk Factors and Frequency for Placental Abruption
Placental abruption is a fairly rare condition that needs immediate attention. It mainly occurs before the 37th week of pregnancy and is one of the leading causes of complications for the mother and death of the baby before or shortly after birth. If a woman has a placental abruption, she faces a high risk of heavy bleeding, which may require blood transfusions, surgical removal of the uterus (hysterectomy), blood clotting disorders—specifically a condition known as disseminated intravascular coagulopathy—as well as kidney failure. These complications could potentially lead to Sheehan syndrome or the death of the pituitary gland after giving birth.
Even with the possibility of replacing lost blood, the risk of death for the mother, though rare, is higher than the average maternal death rate. As for the baby, potential problems include being born early (preterm) and underweight, suffering from lack of oxygen (perinatal asphyxia), being stillborn, or dying shortly after birth. Despite advancements in obstetrical care and monitoring techniques, the rate of placental abruption has been rising in many countries. This suggests that it’s caused by a combination of factors that are not yet fully understood.
Signs and Symptoms of Placental Abruption
Placental abruption is a serious condition that causes vaginal bleeding in the latter half of pregnancy. It can be difficult to accurately diagnose without examining the placenta after birth, so careful patient examination is crucial to proper management and prevention of potential complications.
The process of diagnosing placental abruption begins with the patient’s medical history. This includes examining their prenatal history, such as the location of the placenta in previous sonograms and if they’ve had placental abruption in previous pregnancies. Other lifestyle factors, like smoking or cocaine use, are also taken into consideration, as well as any previous abdominal trauma. This is particularly delicate in cases of potential partner abuse, and any inquiries must be made tactfully and supportively.
- Review of prenatal history
- Previous history of placental abruption
- Lifestyle factors such as smoking or drug use
- History of abdominal trauma
The physical examination is a key part in recognizing placental abruption. The uterus is checked for tenderness, consistency, and the frequency and duration of any contractions. The vaginal area is inspected for bleeding, but a digital cervical examination should be postponed until a sonogram can confirm the placenta’s location and rule out placenta previa. If bleeding is observed, the amount and nature of the blood, as well as the presence of clots, are noted. It’s important to remember that a lack of vaginal bleeding doesn’t rule out a diagnosis of placental abruption.
Vital signs are checked to detect any signs of a hidden hemorrhage, like a rapid heart rate or low blood pressure. A series of blood tests, such as a complete blood count, a fibrinogen level test, a clotting profile, and blood type and RH factor, may be performed to establish a baseline for tracking the patient’s condition – even though these tests don’t directly diagnose placental abruption.
The well-being of the fetus is also considered as part of the examination. This includes listening for fetal heartbeat and asking about any changes in fetal movement. Continuous electronic fetal monitoring is also used to identify any prolonged slow heartbeat, reduced variability, and late decelerations.
Testing for Placental Abruption
Placental abruption, a serious condition in pregnancy, can be challenging to diagnose definitively. Doctors often use various tests and evaluations not specifically to confirm placental abruption but to rule out other possible conditions and gather necessary data.
An ultrasound can help determine the location of the placenta and rule out conditions like placenta previa. However, it’s not as effective in spotting placental abruption. The issue is that during the early stage of this condition, the bleeding can blend in with the surrounding tissue of the placenta, making it hard to see and distinguish.
When managing patients with minor placental abruption, a biophysical profile might be used. This is a test that measures your baby’s health, including heart rate, muscle tone, and amniotic fluid levels. A score of 6 or less can signal your baby’s well-being is at risk.
The doctor might also order blood tests, including a complete blood count (CBC), clotting studies, and a BUN test. These tests provide data that the doctor can use to track any changes in your health. If you need a blood transfusion, a test will be done to determine your blood type.
A special blood test known as the Kleihauer-Betke test might be conducted to detect if your baby’s blood cells are in your circulation. Although this test doesn’t confirm placental abruption, it’s helpful to know the amount of your baby’s blood in your bloodstream, particularly if you have a negative blood type (Rh-negative). If baby’s and mother’s blood has mixed significantly, this test’s results can help determine the dosage of a medication known as Rh immune globulin needed to prevent an immune response called isoimmunization.
Treatment Options for Placental Abruption
If you’re suspected of having placental abruption, a serious condition where the placenta separates from the uterus before a baby is born, immediate treatment is necessary. First, you’ll need advanced life support and a quick vehicle transport to a hospital equipped with specialized resources for pregnant women and newborn babies. Once there, you’ll typically be given fluids through a vein (intravenous or IV fluids), extra oxygen to breathe, and continuous monitoring of you and your baby as doctors assess your condition.
Depending on your individual situation – how severe your symptoms are, how far along you are in your pregnancy, and how much discomfort you or your baby are experiencing – your treatment might vary.
If you have a mild case of placental abruption and there are no signs of distress for you or your baby and your pregnancy is less than 37 weeks along, you may be carefully monitored without any active intervention. This involves staying in the hospital’s maternity ward, where both your health and your baby’s will be watched attentively. You’ll have an intravenous line for potential fluid and medication administration, and blood samples will be taken. This careful observation continues until there’s a change in the condition or until your baby reaches full term.
If your condition is moderate to severe, and your baby is at a viable stage and alive, delivery becomes necessary. Sometimes, due to intense muscle contractions in the uterus, a natural vaginal delivery may happen quite quickly. This method can be safer for you as it carries lesser risk of bleeding problems or disorders related to clotting. However, if your baby shows signs of distress, an emergency cesarean section – a surgical method for delivering a baby – may be the best way to keep your baby safe. Proper management of fluids and blood volume is crucial during this procedure.
After any surgery, close monitoring is needed to check for potential excessive bleeding and changes in blood clotting ability. Additionally, a team of baby doctors should be present at delivery to care for and manage your baby’s health.
What else can Placental Abruption be?
Bleeding during the second part of pregnancy can be caused by two main conditions – placental abruption and placenta previa. It’s important to tell these apart in order to provide the best care for the patient. Here’s how these two conditions often appear in an obstetrical examination:
- The start of symptoms can be sudden and severe for placental abruption, but for placenta previa, they’re often slow and not as noticeable.
- Bleeding during placental abruption can either be visible or hidden, while bleeding with placenta previa is usually visible.
- In the case of placental abruption, the level of anemia or shock might be higher than what the visible blood loss would suggest. With placenta previa, the level of anemia or shock is often on par with the visible blood loss.
- Pain can be intense and immediate with placental abruption, whereas pain doesn’t typically accompany placenta previa.
- The uterus often feels firm and stiff in the case of placental abruption. With placenta previa, the uterus usually feels soft and relaxed.
What to expect with Placental Abruption
The outcome can considerably depend on how soon the patient gets to the hospital. If the bleeding doesn’t stop, both the mother and the baby’s lives could be in danger. A partially separated placenta usually results in less severe outcomes compared to a fully separated one. However, in both situations, without immediate medical intervention, specifically a cesarean section, the baby might not survive. This condition is responsible for 5% to 8% of maternal deaths today.
Possible Complications When Diagnosed with Placental Abruption
Placental abruption, which is when the placenta detaches from the womb before birth, can lead to a number of complications. These can include:
- Severe bleeding
- Death of the baby
- Death of the mother
- The baby being born too early (premature birth)
- Blood clotting problems (coagulopathy)
- Complications related to blood transfusion
- Need for the mother to have her womb removed (hysterectomy)
- Need for the mother to give birth via cesarean section in the future
- 4% to 12% chance of this happening again in future pregnancies
- Increased risk of heart-related complications for the mother