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Placental Abruption

What is placental abruption?
Placental abruption is the early separation of a normal placenta
from the wall of the uterus.
The placenta is an organ that grows in the uterus during
pregnancy to provide nourishment and oxygen to the baby.

How does it occur?
Normally the placenta separates from the uterus and is
delivered right after the birth
of the baby. When placental abruption occurs, the placenta
starts to tear away from the
uterus before the baby is born. It can cause serious
problems for the baby and the mother.

You are at higher risk for placental abruption if you:

become pregnant after age 35
have had more than 4 or 5 children
are pregnant with twins or triplets
have high blood pressure
use cocaine
have diabetes
have had a previous abruption.

What are the symptoms?
The symptoms of placental abruption are:

contractions that don't stop
pain in the uterus
tenderness in the abdomen over the uterus
vaginal bleeding (sometimes).

How is it diagnosed?
The doctor will give you a physical exam, looking for signs
of blood loss. These tests may be done:

blood tests
ultrasound scan to look for a blood clot behind the placenta
nonstress test to check the baby's heart rate and look for
signs of fetal distress.

How is it treated?
The treatment for placental abruption depends on:

how much of the placenta has separated from the uterus
how close the pregnancy is to full term
your health and whether you have other problems, such
as high blood pressure
the amount of blood you have lost
the baby's health.

If the separation of the placenta is small, the baby isn't in
distress, and your condition
is stable, you may be able to go home and continue the
pregnancy with frequent checkups.

If you are admitted to the hospital, you will be given intravenous
(IV) fluids. A fetal monitor
will be used to check the baby for signs of distress. If the
separation is moderate to severe,
your blood pressure, pulse, and amounts of urination will be
closely checked. Lab tests will
be run on your blood to check its ability to clot. You may be
given blood transfusions.

If the separation is moderate to severe but the baby is not in
distress and your condition is
stable, the doctor may induce labor and perform a vaginal
delivery. If the baby is in distress or
if you are losing a lot of blood, the doctor will deliver the baby
immediately by cesarean section.

How long will the effects last?
Sometimes placental abruption begins and then stops without
treatment. As long as you and the
baby are healthy, your pregnancy can continue with frequent
checkups by the doctor. A mild case
of placental abruption will probably have no long-term effects
on your health or your baby's health.

A moderate to severe separation of the placenta may have the
following effects on you after delivery:

A large loss of blood or hemorrhage may require blood transfusions
and intensive care after delivery.
Your uterus may not contract properly after delivery so you may need
medication to help the uterus contract.
You may have problems with blood clotting for a few days.
A severe case of shock may affect other organs of your body, such
as the liver, kidney, and pituitary gland.

Placental abruption may have the following effects on the baby:

If a large amount of the placenta separates from the uterus, the baby
will probably be in distress until delivery.
The baby may be premature and need to be placed in the newborn
intensive care unit. He or she might
have problems with breathing and feeding.
If the baby is in distress in the uterus, he or she may have a low level
of oxygen in the blood after birth.
The newborn may have low blood pressure or a low blood count.
If the separation is severe enough, the baby could suffer brain damage
or die before or shortly after birth.

What can be done to help prevent placental abruption?
Good prenatal care and a healthy diet may prevent high blood
pressure during pregnancy. Prevention of
high blood pressure decreases the risk of abruption.

Placental abruption caused by drug abuse can be prevented if the
mother stops abusing drugs.

Despite these preventive steps, placental abruption may occur
again in the next pregnancy. If you have had
a placental abruption and are pregnant again, be sure to tell your
doctor about it. Get plenty of rest, take
vitamins with folic acid, and immediately report any contractions
or bleeding to your doctor.