Placenta abruptio is a problem with the placenta during pregnancy. The placenta is a round, flat organ that forms during pregnancy to give the baby food and oxygen from the mother. During a normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until the baby has been born. But with placenta abruptio, the placenta breaks away, or abrupts, from the wall of the uterus too early, before the baby is born. This problem can cause:
Placenta abruptio can be very harmful for both the mother and the baby. In rare cases, it can cause death.
See a picture of placenta abruptio.
Placenta abruptio is also called abruptio placenta or placental abruption. It affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th week of pregnancy.
Doctors aren't sure what causes placenta abruptio. But there are things that raise a woman’s risk for an abruption. These things are called risk factors. If you avoid them, you can lower your risk.
Common risk factors for placenta abruptio include:
Less common risk factors for placenta abruptio include:
If you have placenta abruptio, you may notice one or more warning signs. Call your doctor right away if you are pregnant and have any of these symptoms:
Call 911 or emergency services right away if you have:
You can't really tell how serious an abruption is by the amount of vaginal bleeding. There might be a serious problem even if there is only a little bleeding. Sometimes the blood can be trapped between the placenta and the wall of the uterus. In rare cases, symptoms of shock will be the only signs that there is a problem.
Your doctor will ask questions about your symptoms and will check your baby’s heart rate. You may have an ultrasound test. Your doctor might also do a blood test to see if you're anemic from losing blood.
If your doctor thinks that you have a placental abruption, you'll likely have to stay in the hospital for at least a few hours. Your doctor will need to find out how severe the abruption is, if it is getting worse, and if it is affecting your baby.
The kind of treatment you will have depends on:
If you have a mild abruption, it may get better on its own. You may just be closely watched for the rest of your pregnancy. You may not have to stay in the hospital.
A medium to severe abruption means that you will likely have to stay in the hospital so that the baby's health can be watched closely. In most cases, the baby will need to be delivered, sometimes by emergency cesarean section.
Learning about placenta abruptio:
Not every woman with placenta abruptio has symptoms.
If you have placenta abruptio, you may notice one or more symptoms, including:
In rare cases, when heavy blood loss is retained in the uterus behind the placenta, the only signs of placenta abruptio are symptoms of shock. Early signs of shock (most of which are present at the same time) include:
High blood pressure (hypertension) is the most common risk factor associated with placenta abruptio. For more information, see the topic Preeclampsia and High Blood Pressure During Pregnancy.
A separation of the placenta from the uterine wall, or placenta abruptio, can be difficult to identify. Diagnosis is based on a physical exam, a medical history, and a process of elimination. Testing may include:
A placenta that has separated from the uterine wall (placenta abruptio) cannot be repaired. Until its severity can be assessed, placenta abruptio is considered a medical emergency. If you have suspected or diagnosed placenta abruptio, you will need to be observed in the hospital. Some abruptions can get worse quickly and become life-threatening for both you and your fetus.
If your blood type is Rh-negative and you have placenta abruptio, you will have an Rh immune globulin shot, such as RhoGAM. This is because your fetus could be Rh-positive. Bleeding from an abruption can mix the Rh-positive blood with yours. The Rh immune globulin prevents your immune system from attacking the Rh-positive blood.
If placental separation is minor, vaginal bleeding is light, and your fetus is not in distress, you may be observed in the hospital for several hours or several days. For the remainder of your pregnancy, you'll probably be advised to avoid strenuous activities, and you and your fetus will need to be monitored regularly.
If placental separation is moderate to severe, or if it causes a life-threatening condition called disseminated intravascular coagulation (DIC), rapid delivery is almost always necessary. Although vaginal delivery is sometimes possible, the need for rapid delivery increases the likelihood of a cesarean (C-section). In rare cases of heavy bleeding that won't stop, the uterus is surgically removed (hysterectomy).
Depending on how much blood you have lost and whether you have disseminated intravascular coagulation, you may need a transfusion of blood or blood-clotting products, such as platelets.
How well your baby does after a placental abruption depends on how prematurely he or she is delivered and how well the placenta was able to circulate blood oxygen and nutrients to the fetus before delivery.
Following delivery, it may be necessary to remain close to a health center able to care for premature infants. A sick or premature newborn can receive the best treatment possible in a neonatal intensive care unit, or NICU. Care in the NICU can last days or weeks, depending on the baby's level of maturity, the extent of the baby's problems, and the amount of care needed. For more information, see the topic Premature Infant.
Treatment for premature infants can be provided by a neonatologist, a doctor who specializes in the care of newborns.
After having one placental abruption, you have an increased risk of developing another during a future pregnancy. After two or more, you have a 1-in-4 risk of having another.2 Although there are no specific treatment guidelines for preventing another placental abruption, you and your health professional can take some steps to reduce your risk.
Although most cases of placenta abruptio cannot be directly prevented, you can avoid or treat factors that are known to greatly increase your risk of placental abruption.
Even during a healthy pregnancy, placenta abruptio is a possible complication. But you can optimize your fetus's and your ability to handle a medical complication by making healthy lifestyle choices and having regular prenatal checks throughout your pregnancy. For more information, see the topic Pregnancy.
Call 911 or other emergency services immediately if you have:
During pregnancy, pay attention to symptoms or injuries that can be related to the placenta separating from the uterine wall (placenta abruptio). Call your health professional immediately if you are pregnant and you experience:
Should your baby die as a result of placenta abruptio, allow yourself permission and time to grieve your loss. Your partner, children, and other family members may also need time to grieve.
Contacting a support group, reading about the experiences of other women, and talking to your doctor, friends, a counselor, or a member of the clergy may help you and your family deal with your loss. For more information, see the topic Grief and Grieving.
If you have plans to become pregnant after having had placenta abruptio, talk to your health professional ahead of time about maximizing your chances of a healthy pregnancy in the future.
|American Congress of Obstetricians and Gynecologists (ACOG)|
|409 12th Street SW|
|P.O. Box 96920|
|Washington, DC 20090-6920|
American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.
|March of Dimes|
|1275 Mamaroneck Avenue|
|White Plains, NY 10605|
The March of Dimes tries to improve the health of babies by preventing birth defects, premature birth, and early death. March of Dimes supports research, community services, education, and advocacy to save babies' lives. The organization's website has information on premature birth, birth defects, birth defects testing, pregnancy, and prenatal care.
- Kay HH (2008). Placenta previa and abruption. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 387–399. Philadelphia: Lippincott Williams and Wilkins.
- Miller DA (2010). Placenta previa and abruption placentae. In Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 57–61. Chichester: Wiley-Blackwell.
Other Works Consulted
- Cunningham FG, et al. (2010). Placenta abruption section of Obstetrical hemorrhage. In William's Obstetrics, 23rd ed., pp. 757–795. New York: McGraw-Hill.
- Greenburg JA, et al. (2011). Folic acid supplementation and pregnancy: More than just neural tube defect prevention. Reviews in Obstetrics and Gynecology, 4(2): 52–59.
- Scearce J, Uzelac PS (2007). Third-trimester vaginal bleeding. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 328–341. New York: McGraw-Hill.
- Williams DE, Pridjian G (2011). Obstetrics. In RE Rakel, DP Rakel, eds., Textbook of Family Medicine, 8th ed., pp. 359–401. Philadelphia: Saunders.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||William Gilbert, MD - Maternal and Fetal Medicine|
|Last Revised||February 3, 2012|
Last Revised: February 3, 2012
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