According to the American Pregnancy Association, fetal death occurs in 15 percent of severe placental abruption instances.
Placental abruption or abruptio placentae is a condition that occurs as a complication of pregnancy in which there is premature separation of the placenta from the uterine wall. It most commonly occurs in the late pregnancy beyond 28 weeks.
The placenta is an organ that develops during pregnancy and is attached to the uterine wall to supply all the nutritional requirements needed for the development of the fetus.
- Placental abruption leads to deprived oxygen and nutrient supply to the fetus and causes heavy bleeding in the mother.
- It is relatively rare and affects about one percent of women during pregnancy but a serious complication in which the health of both mother and child is at risk and requires immediate management.
- It is critical to get immediate care for a probable placental abruption.
According to the American Pregnancy Association, fetal death occurs in 15 percent of severe placental abruption instances. The survival of the baby following a placental abruption largely depends on the severity of abruption and fetal age.
The exact cause of placental abruption is unknown. However, certain factors, such as lifestyle and abdominal injuries, can increase the risk of it.
What are the different types of placental abruption?
Placental abruption occurs when the blood vessels of the mother get separated from the placenta and bleeding starts to occur between the uterine lining and the maternal side of the placenta. The accumulated blood pushes and separates the placenta away from the uterine wall.
- As the placenta is the source of oxygen and nutrients, diffusion to and from the maternal circulatory system is essential to maintain the functions of the placenta.
- When the trapped blood causes the placenta to separate from the maternal vasculature, these vital functions of the placenta are interrupted.
Insufficient blood supply may affect fetal viability and may lead to intrauterine death of the fetus.
The two main types of placental abruption include:
- Concealed abruptio placentae: Lower edge of the placenta is intact and the blood gets collected behind the placenta. Retroplacental (behind the placenta) blood may reach up to the outermost layer of the uterus and the uterus appears wine-colored. This type of uterus is called couvelaire uterus or uteroplacental apoplexy.
- Revealed abruptio placentae: In this type, the lower edge of the placenta separates from the uterine wall and manifests as antepartum (occurring before the birth of the baby) hemorrhage.
What are the risk factors of placental abruption?
The most important risk factor of placental abruption in women with a previous history of abruptio placentae.
Other risk factors of placental abruption include:
- Aged older than 35 years
- Trauma (fall or blow to the abdomen)
- Polyhydramnios (presence of excessive amniotic fluid in the uterus)
- Retroplacental fibroid
- Multiple pregnancies
- Hypertension
- Smoking or cocaine use
- Folic acid deficiency
- Multiparity
- Thrombophilia (a blood clotting disorder)
What are the signs and symptoms of placental abruption?
Placental abruption is one of the reasons for bleeding through the vagina in late pregnancy.
The woman may experience signs and symptoms, such as:
- Vaginal bleeding (may be absent in concealed placental abruption)
- Abdominal pain
- Back pain radiating
- Uterine tenderness or rigidity
- Uterine contractions
How is placental abruption treated?
The diagnosis of placental abruption is often done with the clinical assessment of the patient and is confirmed with correlation from ultrasound. The patient with a suspected placental abruption often requires hospitalization with a full-service obstetrical unit and a neonatal intensive care unit.
The treatment is administered mainly based on the severity of the condition and fetal maturity.
- In mild placental abruption where bleeding is minimal and fetal heart rate is normal, close monitoring and steroids administration for lung maturity of the fetus are done. If the pregnancy is above 34 weeks of gestation, closely monitored vaginal delivery can be done.
- In severe placental abruption, immediate induction of labor irrespective of gestational age is done along with blood transfusion and close monitoring of vital signs.
