Placental abruption

The placenta attaches to the wall of the uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. It can separate partially or completely. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have serious bleeding.

Normally, the placenta grows onto the upper part of the uterus and stays there until your baby is born. During the last stage of labor, the placenta separates from the uterus, and your contractions help push it into the vagina (birth canal). This is also called the afterbirth.

About 1 in 100 pregnant women (1 percent) have placental abruption. It usually happens in the third trimester, but it can happen any time after 20 weeks of pregnancy. Mild cases may cause few problems. An abruption is mild if only a very small part of the placenta separates from the uterus wall. A mild abruption usually isn’t dangerous.

If you have severe placental abruption (greater separation between the placenta and the uterus), your baby is at higher risk for:

  • Growth problems
  • Premature birth – birth that happens too early, before 37 completed weeks of pregnancy
  • Stillbirth – when a baby dies in the womb before birth, but after 20 weeks of pregnancy

Placental abruption is related to about 1 in 10 premature births (10 percent). Premature babies (born before 37 completed weeks of pregnancy) are more likely than babies born later to have health problems during the first weeks of life, lasting disabilities, and even death.

What are the symptoms of placental abruption?
The main symptom of placental abruption is vaginal bleeding. You also may have discomfort and tenderness or sudden, ongoing belly or back pain. Sometimes, these symptoms may happen without vaginal bleeding because the blood is trapped behind the placenta. If you have any of these symptoms, call your health care provider.

How is placental abruption diagnosed?
If your provider thinks you are having an abruption, you may need to get checked at the hospital. Your provider can look for abruption by doing a physical exam and an ultrasound. An ultrasound can find many, but not all, abruptions.

How is placental abruption treated?
Treatment depends on how serious the abruption is and how far along you are in your pregnancy.
Your provider may simply monitor you and your baby. But sometimes you may need to give birth right away.

If you need to give birth right away, your provider may give you medicines called corticosteroids. These medicines help speed up development of your baby’s lungs and other organs.

Mild placental abruption
If you have a mild abruption at 24 to 34 weeks of pregnancy, you need careful monitoring in the hospital. If tests show that you and your baby are doing well, your provider may give you treatment to try to keep you pregnant for as long as possible. Your provider may want you to stay in the hospital until you give birth. If the bleeding stops, you may be able to go home.

If you have a mild abruption at or near full term, your provider may recommend inducing labor or cesarean birth (c-section). You may need to give birth right away, if:

  • The abruption gets worse.
  • You are bleeding heavily.
  • Your baby is having problems.

Moderate or severe placental abruption
If you have a moderate to severe abruption, you usually need to give birth right away. Needing to give birth quickly may increase your chances of having a c-section.

If you lose a lot of blood due to the abruption, you may need a blood transfusion. It’s very rare, but if you have heavy bleeding that can’t be controlled, you may need a hysterectomy. A hysterectomy is when your uterus is removed by surgery. A hysterectomy can prevent deadly bleeding and other problems in your body. But it also means that you can’t get pregnant again in the future.

What causes placental abruption?
We don’t really know what causes placental abruption. You may be at higher risk for placental abruption if:

If you’ve had a placental abruption before, what are your chances of having it again?
If you’ve had a placental abruption in a past pregnancy, you have about a 1 in 10 (10 percent) chance of it happening again in a later pregnancy.

How can you reduce your risk for abruption?
In most cases, you can’t prevent abruption. But you may be able to reduce your risk by getting treatment for high blood pressure, not smoking or using street drugs, and always wearing a seatbelt when riding in a car.

Last reviewed January 2012

See also: Placenta Previa, Placental accreta, increta and percreta

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

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