Placental Abruption

Overview

What is a placental abruption?

Placental abruption is a complication of pregnancy that happens when the placenta separates from your uterus before your baby is born. The placenta is a temporary organ that connects a growing baby to your uterus during pregnancy. It attaches to the wall of your uterus, usually on the top or side and acts as a lifeline that gives nutrients and oxygen to your baby through the umbilical cord. The placenta also removes waste from your baby’s blood.

In placental abruption, the placenta may completely detach or partially detach. This can decrease the amount of oxygen and nutrients to your baby and cause heavy bleeding in the mother. Placental abruption is a serious condition that requires medical treatment.

What are the different types of placental abruption?

  • A partial placental abruption occurs when the placenta does not completely detach from the uterine wall.
  • A complete or total placental abruption occurs when the placenta completely detaches from the uterine wall. There is usually more vaginal bleeding associated with this type of abruption.
  • Revealed placental abruptions have moderate to severe vaginal bleeding that you can see.
  • Concealed placental abruptions have little or no visible vaginal bleeding. Blood is trapped between the placenta and uterine wall.

What is the difference between placental abruption and placenta previa?

In placenta previa, the placenta is covering all or part of the mother’s cervix. It's also called low-lying placenta. Think of it as an obstacle that’s blocking the exit from the uterus. Even though the placenta is in a complicated position, it’s still attached to the uterus. When the placenta detaches from the uterus, this is a placental abruption. Both conditions can cause vaginal bleeding during pregnancy and labor.

How common is a placental abruption?

About 1 out of 100 pregnancies has placental abruption. This condition is usually seen in the third trimester, but it can happen any time after 20 weeks of pregnancy up until delivery.

What are the effects of placental abruption?

Placental abruption can be life-threatening to your baby and sometimes to you. Complications from a placental abruption include:

For baby:

For mother:

Symptoms and Causes

What causes placental abruption?

The cause of placental abruption is often unknown. Certain lifestyle choices or abdominal trauma can increase your risk for placental abruption.

What are the risk factors for placental abruption?

You are at higher risk for placental abruptions if you have any of the following:

  • Trauma or injury to your uterus (like a car accident, fall or blow to the stomach).
  • Previous placental abruption.
  • Multiple gestations (twins or triplets).
  • High blood pressure (hypertension), gestational diabetes or preeclampsia.
  • If you smoke or have a history of drug use.
  • Short umbilical cord.
  • Maternal age 35 or greater.
  • Uterine fibroids.
  • Thrombophilia (a blood clotting disorder).
  • Premature rupture of membranes (the water breaks before your baby is full term).
  • Rapid loss of the amniotic fluid.

What are the signs and symptoms of placental abruption?

Each person can have different symptoms of placental abruption. However, the most common symptom is vaginal bleeding with cramping during the third trimester of pregnancy. Symptoms or signs can also include:

  • Abdominal pain.
  • Uterine contractions that are longer and more intense than average labor contractions.
  • Uterine tenderness.
  • Backache or back pain.
  • Decreased fetal movement.

Vaginal bleeding can vary and is not an indication of how much the placenta has separated. In some instances, there could be no visible bleeding because the blood is trapped between the placenta and the uterine wall. Pain can range from mild cramping to strong contractions and often begins suddenly.

These symptoms can resemble other pregnancy conditions. Always consult with your healthcare provider for a diagnosis.

Do you always bleed during a placental abruption?

Most of the time, you will see some blood during a placental abruption. In the event of a concealed abruption, the blood will be behind the placenta. In that case, there will be no bleeding. In other cases, the abruption develops slowly, which can cause occasional, light bleeding.

Talk to your healthcare provider about any vaginal bleeding you experience during your pregnancy.

What does placental abruption feel like?

You may experience sudden or sharp pain, cramping, or tenderness in your lower pelvic region or back during a placental abruption. You could also feel your baby move less. You should discuss these symptoms with your healthcare provider immediately.

What are the first signs of a placental abruption?

The most common symptom of a placental abruption is vaginal bleeding, although you will not always bleed. You may also have sudden, ongoing pain in your abdomen or back.

Diagnosis and Tests

How is a placental abruption diagnosed?

Placental abruption is diagnosed through an exam and monitoring. You may be admitted to the hospital depending on the severity of the abruption or you may be able to rest at home. Your healthcare provider will:

  • Ask how much bleeding has occurred.
  • Ask where you feel pain and how intense the pain is.
  • Ask when symptoms started.
  • Monitor your blood pressure.
  • Monitor the baby’s heart rate and movement.
  • Monitor your contractions.
  • Use ultrasound to locate the bleeding and to check your baby.
  • Recommend blood or urine tests.

There are typically three grades of placental abruption a healthcare provider will diagnose:

  • Grade 1: Small amount of bleeding, some uterine contractions, and no signs of fetal or maternal stress.
  • Grade 2: Mild to moderate amount of bleeding, some uterine contractions, and signs of fetal stress.
  • Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions that do not relax, abdominal pain, low maternal blood pressure, and fetal death.

It is important to discuss any symptoms or changes in symptoms with your healthcare provider.

Management and Treatment

How is a placental abruption treated?

Once the placenta has separated from the uterus, it cannot be reconnected or repaired. A healthcare provider will recommend treatment based on:

  • The severity of the abruption.
  • How long the pregnancy is/gestational age of your unborn baby.
  • Signs of distress from your unborn baby.
  • Amount of blood you've lost.

Generally, the severity of the abruption and gestational age of your baby are the two most important factors:

If your baby is not close to full term:

  • If it's too soon for your baby to be born and your abruption is mild, you will be closely monitored until you reach 34 weeks of pregnancy. If your baby’s heart rate is normal and you're not bleeding, your healthcare provider may allow you to go home to rest. They may give you medication to help with your baby’s lung development.
  • If your abruption is severe and the health of you or your baby are at risk, immediate delivery may be necessary.

If your baby is near full term:

  • If your abruption is mild and the baby’s heart rate is stable, a closely monitored vaginal delivery is possible. This is generally determined around 34 weeks of pregnancy.
  • If the abruption gets worse or you or your baby are in danger at any time, the baby will be delivered via emergency Cesarean section.

Prevention

Can I prevent a placental abruption?

Placental abruptions are typically unpreventable. You can reduce your risk by:

  • Not smoking or using drugs.
  • Keeping your blood pressure at a healthy level.
  • Keeping diabetes under control.
  • Taking health and safety precautions like wearing a seat belt.
  • Reporting any abdominal trauma to your healthcare provider.
  • Talking to your healthcare provider about any vaginal bleeding.

Outlook / Prognosis

What can I expect if I have a placental abruption?

This can vary depending on the severity of your symptoms and how far along you are in your pregnancy. You can expect to be monitored closely and often. Watch for any changes in symptoms and discuss them with your healthcare provider immediately.

What is my baby’s survival rate after a placental abruption?

The two factors that affect survival rate are gestational age at birth and the severity of the abruption. Early detection, close monitoring, and quick treatment can help reduce complications.

Can I have another placental abruption?

You have about a 15% chance of having another abruption in a future pregnancy. With two prior abruptions, this chance increases to about 25%. If you have had a previous abruption, please let your healthcare provider know.

What are questions I should ask my healthcare provider?

Your healthcare provider should be able to answer your questions and prepare you for treatment of placental abruption. Here are some questions you might ask:

  • Is my baby’s life in danger? Is mine?
  • What are my treatment options?
  • Can my baby be born now?
  • How will I know if my abruption is worsening?
  • What are potential complications?
  • Do I need additional tests?

Frequently Asked Questions

Can sex cause a placental abruption?

Sexual intercourse is not a direct cause of placental abruption. In most cases, it’s perfectly safe to have sex during pregnancy. Activities with a high risk of falling or abdominal trauma should be avoided during pregnancy.

Can sneezing cause a placental abruption?

Sneezing is a normal thing your body does and is not a cause for placental abruption. It cannot harm your baby in any way. If you have any concerns about frequent and forceful sneezing or coughing, reach out to your healthcare provider for guidance.

Can smoking cause a placental abruption?

Smoking can increase your risk of many complications during pregnancy, including placental abruption. Ask your healthcare provider about ways to quit smoking.

When do I call my healthcare provider if I suspect a placental abruption?

Call your healthcare provider immediately if are bleeding, cramping or experience pelvic pain during your pregnancy, especially in the third trimester.

A note from Cleveland Clinic

Placental abruption is an uncommon, yet serious condition women can experience during pregnancy. Talk to your healthcare provider if you experience vaginal bleeding, pelvic pain or cramping. Placental abruption should be diagnosed and treated promptly to ensure you and your baby are healthy.

Last reviewed by a Cleveland Clinic medical professional on 07/07/2021.

References

  • Nugent, F.; Thomson, A.J.. Munro Kerr's Operative Obstetrics 13th Edition. Edinburgh: Saunders Elsevier, 2020. Accessed 6/15/2021.
  • Hull, Andrew D. et al: Placenta previa and accrete, vasa previa, subchorionic hemorrhage, and abruptio placentae In: Robert Resnik MD and Robert M. Silver MD. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed, Elsevier; 2019: 786-97, Accessed 6/15/2021.
  • Hall DR: Abruptio placentae and disseminated intravascular coagulopathy. Semin Perinatol. 33(3):189-95, 2009. Accessed 6/15/2021.
  • Ananth CV et al: Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol. 214(2):272.e1-e9, 2016. Accessed 6/15/2021.
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  • March of Dimes®. . Accessed 6/15/2021Placental abruption (https://www.marchofdimes.org/complications/placental-abruption.aspx)
  • The American College of Obstetricians and Gynecologists. . Accessed 6/15/2021.Bleeding During Pregnancy (https://www.acog.org/Patients/FAQs/Bleeding-During-Pregnancy?IsMobileSet=false)
  • Schmidt P et al. 2019. . StatPearls. Accessed 6/15/2021.Placental abruption (https://www.ncbi.nlm.nih.gov/books/NBK482335/)

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