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Placental abruption

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Placentalabruptionmeanstheplacentahasdetached(comeaway)fromthewalloftheuterus,
eitherpartlyortotally.Thiscancausebleedinginthemother.Itmayalsointerferewiththeunborn
babyssupplyofoxygenandnutrients,whichtheplacentaprovidesfromthemothersbloodstream
throughtheliningoftheuterus.
Doctorscannotreattachtheplacenta.Withoutpromptmedicaltreatment,aseverecaseof
placentalabruptioncanhavedireconsequencesforthemotherandherunbornchild,including
death.
Worldwide,placentalabruptionoccursinaboutonepregnancyinevery100.Inabouthalfofcases,
placentalabruptionismildandcanbemanagedbyongoingclosemonitoringofthemotherand
baby.About25percentofcasesaremoderate,whiletheremaining25percentthreatenthelifeof
bothbabyandmother.

Symptoms
Someofthesymptomsandsignsofmoderatetosevereplacentalabruptioninclude:

Bleeding,mostcommonlynoticedwhenthewomanstartsbleedingfromthevagina
Continuousabdominalpain
Continuouslowerbackpain
Painfulabdomen(belly)whentouched
Tenderandharduterus
Veryfrequentuterinecontractions
Fetaldistressforexample,abnormalheartrhythm.

Insomecases,bleedingmayoccurbutthebloodmayclotbetweentheplacentaandthewallof
theuterus,sovaginalbleedingmaybescantyorevennon-existent.Thisisknownasa
retroplacentalclot.

The cause is unknown in most cases

Inmostcases,doctorsdontknowtheexactcauseorcausesofplacentalabruption.Itisthought
thatanabnormalbloodsupplyintheuterusorplacentamayplayarole,butthecauseofthe
suspectedabnormalityisntclear.
Someoftheknowncausesofplacentalabruptioninclude:

Abdominal traumaaninjurytothepregnantwomansabdomenmayteartheplacenta
fromthewalloftheuterus.Examplesofeventsthatmaycausethistypeofinjurycould
includeacaraccident,assaultorfall.
Uterine decompressionthisisasuddenlossofamnioticfluidfromtheuterus,which
cansucktheplacentafromtheuteruswall.Possiblecausesofuterinedecompression
includethebirthofthefirsttwin(ormultiple)orruptureofamnioticmembraneswhen
thereisexcessiveamnioticfluid.

Risk factors
Whiletheexactcauseinmostcasesisunknown,certainfactorsmakeapregnancymore
susceptibletoplacentalabruption.Riskfactorsmayinclude:

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Advanced maternal ageoldermothersareatincreasedriskofarangeofpregnancy

complications,includingplacentalabruption.
Prior pregnancytheriskincreasesthemorepregnanciesawomanhashad.
Multiple fetusescarryingtwins,triplets,quadsormoreincreasestheriskofplacental
abruptioncomparedtocarryingasinglefetus.
Prior placental abruptionifawomanhashadtheconditionbefore,sheisathighrisk
ofhavingitagain.
Hypertensionhighbloodpressureincreasestheriskofabnormalbleedingbetweenthe
placentaandthewalloftheuterus.Innearlyhalfofplacentaabruptioncases(44%),the
pregnantmotherishypertensive.Oneofthemostcommoncausesofhypertensionduring
pregnancyisaconditionknownaspre-eclampsia.
Excessive amniotic fluid (polyhydramnious)morefluidthannormalincreasesthe
riskofbleedingbetweentheplacentaandtheuteruswall.
Substance usecigarettesmoking,alcoholuseandtakingdrugssuchas
methamphetamineorcocaineduringpregnancyincreasetheriskofplacentaabruptionas
wellasarangeofotherserioushealthproblemsforbothmotherandunbornbaby.
Some blood conditionsparticularlyanyconditionthataffectsthebloodsabilitytoclot.
Amniocentesisaprenataltestthatinvolvesaneedleinsertedthroughthemothers
abdomenandintotheuterustowithdrawamnioticfluid.Veryrarely,theneedlepuncture
causesbleeding.
Amnioreduction theprenatalconditionoftoomuchamnioticfluidiscalled
polyhydramnious.Amnioreductionisaproceduretoremoveexcessamnioticfluidusinga
needleinsertedthroughthemothersabdomenintotheuterus.Thisprocedure
uncommonlycausesbleeding.
External cephalic versionthedoctorusesultrasoundimagingandexternalmassageon
themothersabdomentotrytoturnthebabyfromahead-upposition(breech)toaheaddownpositioninreadinessforchildbirth.Thisprocedurecanoccasionally(rarely)dislodge
theplacenta.

Complications
Complicationsinseverecasescaninclude:

Decreasedoxygentothebaby,whichcouldleadtobraindamage
Stillbirth
Maternalbloodlossleadingtoshock
Emergencyhysterectomy(surgicalremovaloftheuterus)ifthebleedingcannotbe
controlled
Maternaldeathfromseverebloodloss.

Diagnosis
Thesymptomsandsignsofplacentalabruptioncanmimicthoseofotherpregnancyconditions,
suchasplacentapreviaandpre-eclampsia.Informationthatmaybeusedtodiagnoseplacental
abruptionincludes:

Medicalhistory
Physicalexamination,includingcheckingthetendernessandtoneoftheuterus
Internalexaminationofthevaginaandcervix,usingaspeculum
Bloodtests
Ultrasoundtochecktheplacenta
Fetalheartbeatmonitoring.

Sometimes,thediagnosisofplacentalabruptioncantbeconfirmeduntilchildbirth,whenthe
placentaisdeliveredwithanattachedbloodclotthatappearsoldratherthanfresh.Theplacentais
usuallysenttoalaboratoryforfurtherdiagnostictesting.

Treatment
Allcasesofsuspectedplacentalabruption,regardlessofseverity,shouldbecloselymonitoredto
protectthehealthandsafetyofthemotherandchild.Thismonitoringisusuallydoneinhospital
andshouldincluderegularchecksofthevitalsignsofbothmotherandbaby.Treatmentdepends
ontheseverityoftheconditionbutmayinclude:

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Mild cases, earlier in pregnancyifthebabyisntdistressedandifthevaginalbleeding

stops,youmaybeallowedtogohomeandrest.Seeyourdoctorforregularcheck-upsand
ifyourconditionchanges.
Moderate cases, earlier in pregnancyyoumayneedtostayinhospitaluntilthebaby
isoldenoughforthedoctortosafelyinducelabour.Thedoctormayrecommendmedicines
tohelpthebabyslungsmaturemorequicklypriortobirth.
Mild to moderate cases, later in pregnancyat36weeksgestationormore,the
doctormayrecommenddelivery.Avaginalbirthmaybepossible.However,iftheplacenta
separatesfurtherfromthewalloftheuterusduringlabour,thedoctormayswitchto
immediatedeliveryviacaesareansection.
Severe casesimmediatedeliveryisthesafesttreatment.Themothermayrequire
supportivecare.Heavymaternalbleedingmaybetreatedwithabloodtransfusionor
emergencyhysterectomyorboth.

Prevention
Whileitisimpossibletopreventplacentalabruption,theriskcanbereduced.Suggestionsinclude:

Avoidallsubstancesduringpregnancyincludingcigarettes,alcohol,medicines(unless
prescribedbyyourdoctor)andstreetdrugs.
Controlhighbloodpressure.Consultwithyourdoctorforinformation,adviceand
treatment.
Reduceyourriskoftraumaforexample,wearaseatbeltwhentravellinginacarand
avoidthepossibilityoffalls.
Talktoyourdoctorifyouhavehadplacentalabruptioninapreviouspregnancy.
Takefolicacidasrecommendedbyyourdoctorormidwife.

Where to get help

AlwayscallanambulanceinanemergencyTel.000
Yourdoctor
Obstetrician
NURSE-ON-CALLTel.1300606024forexperthealthinformationandadvice(24hours,
7days)
Emergencydepartmentofyournearesthospital

Things to remember

Placentalabruptionmeanstheplacentahasdetachedfromthewalloftheuterus,either
partlyortotally.Thiscancausebleedinginthemotherandmayinterferewiththebabys
supplyofoxygenandnutrients.
Thecauseisunknowninmostcases,butriskfactorsmayincludematernalhighblood
pressure,abdominaltraumaandsubstancemisuse.
Withoutpromptmedicaltreatment,aseverecaseofplacentalabruptioncanhavedire
consequencesforthemotherandherunbornchild,includingdeath.

This page has been produced in consultation with, and approved by:

RoyalAustralianandNewZealandCollegeofObstetriciansandGynaecologists

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