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Placental abruption, also referred to as abruptio placentae, is a serious complication of pregnancy that requires immediate medical attention, Placental abruption occurs when the placenta is partially or entirely separates from the uterus’ inner wall prior to delivery.
This may result in the fetus receiving less oxygen and nutrition, as well as causing the parent to have significant bleeding. Abdominal pain and bleeding are possible symptoms, particularly in the third trimester.
A healthcare professional will determine the diagnosis and cause of action for a placental abruption based on the extent of the separation and the fetus’ gestational age. If placental abruption is left untreated, it puts both the mother and the child in danger.
Different types of placental abruption are:
- Total or complete: When the placenta entirely separates from the uterine wall, it causes a complete or total placental abruption. With this kind of abruption, the vaginal bleeding is typically more severe.
- Partial: When the placenta partially separates from the uterine wall, this is known as a partial placental abruption.
- Revealed: Moderate to severe vaginal bleeding that is visible.
- Concealed: Vaginal bleeding from concealed placental abruptions is minimal or absent. Between the placenta and uterine wall, the blood is trapped.
Symptoms
Placental abruption symptoms vary from person to person. The last trimester of pregnancy, especially in the final few weeks before delivery, is when placental abruption is most likely to happen. Signs and symptoms of placental abruption include:
- Abdominal pain
- Back pain
- Vaginal bleeding
- Uterine tenderness
- Uterine contractions that are longer than the usual labor
Vaginal bleeding can vary significantly in volume, and it is not always clear how much of the placenta has actually detached from the uterus. Due to the trapped blood between the placenta and the uterine wall, there could not be any visible bleeding. Pain might start unexpectedly and ranges from light cramps to painful contractions.
It is recommended to seek medical attention if the patient experience any sign and symptoms of placental abruption during the pregnancy.
Causes
Placental abruption occurs from unknown causes. It could be caused by the sudden loss of the fluid that surrounds and cushions the developing baby in the uterus, or trauma, or injury to the abdomen, such as that caused by a fall or an automobile accident.
Risk factors
The following factors can raise the risk of placental abruption:
- Uterine trauma or injury
- History of placental abruption
- Chronic high blood pressure (hypertension)
- Hypertension (high blood pressure), preeclampsia, HELLP syndrome, eclampsia, gestational diabetes
- Smoking or drug use (such as cocaine) during pregnancy
- Premature rupture of membranes (leaking of amniotic fluid before full term)
- Infection in the uterus while pregnant (chorioamnionitis)
- Being older, especially older than 40
- Sudden loss of amniotic fluid
- Short umbilical cord
Diagnosis
Healthcare provider will perform physical examination of the uterus to evaluate for the tenderness or rigidity. If there are vaginal bleeding, healthcare provider will recommend blood test, urine test, and ultrasound, high-frequency sound waves used during an ultrasound provide an image of your uterus on a monitor. However, a placental abruption may not always be seen on an ultrasound.
A healthcare provider will commonly diagnose placental abruption in three grades:
- Grade I: Only a small amount of bleeding, a few contractions, and no indications of stress in either the mother or the fetus.
- Grade II: Bleeding that is mild to moderate, some uterine contractions, and indications of fetal stress
- Grade III: Moderate to severe bleeding, undetected hemorrhage, intractable uterine contractions, abdominal discomfort, hypotension, and fetal death are all possible outcomes.
Treatment
It is impossible to reconnect or repair the placenta once it has detached from the uterus. Depending on the situation, there are different placental abruption treatment options:
- The fetus is not in full term: If the abruption is mild and it is too early for delivery, the patient will be closely monitored until 34 weeks. The healthcare provider might let the patient go home to rest if the fetal heart rate is normal and if there are no signs of bleeding. In the event that an early birth is required, the patient might be prescribed medication to assist in the development of the baby’s lungs and to protect the baby’s brain.
- The fetus is near full term: It is possible to deliver vaginally under close observation if the abruption is minor and the fetal heart rate is stable. Around week 34 of pregnancy, this is typically determined. The baby will be delivered via emergency Cesarean section if the abruption worsens or if the patient or the fetus are ever in danger.
