Symtoms, causes, risks of placental abruption

Maxwell Adeyemi

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

In placental abruption, the placenta may completely or partially detach. This can decrease the amount of oxygen and nutrients the foetus gets. It can also cause heavy bleeding in the birthing parent. Your healthcare provider will need to monitor you closely and determine if an early delivery is necessary.

Types of

placental abruption

The classification of placental abruption can be based on how much the placenta detaches from the uterus:

A partial placental abruption occurs when the placenta doesn’t completely detach from the uterine wall.

A complete or total placental abruption occurs when the placenta completely detaches from the uterine wall. There’s usually more vaginal bleeding with a complete abruption.

It can further be classified by how much bleeding occurs:

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.

Placental abruption occurs in about one out of 100 pregnancies (one per cent). It most commonly occurs later in the third trimester, which begins around 28 weeks of pregnancy and lasts until delivery (around 40 weeks), but it can occur any time after 20 weeks.

Symptoms

Each patient can have different symptoms of placental abruption. But the most common symptom is vaginal bleeding with cramping during the third trimester of pregnancy.

Other symptoms include: abdominal pain, uterine contractions that are longer and more intense than typical labour contractions, uterine tenderness, backache or back pain, feeling the foetus move less.

Vaginal bleeding can vary and is not an indication of how severe the abruption is. 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 that come on suddenly.

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

Causes of

placental abruption

The cause of placental abruption is often unknown. But there are factors that increase your risk for an abruption. For example, abdominal trauma, such as from a fall or accident, can increase your risk for placental abruption, a blow to your belly (such as in a car accident or falling down the steps) can cause the placenta to detach.

Risk factors for

placental abruption

The following factors increase your risk of placental abruption:

* Trauma or injury to your uterus (like a car accident, fall or blow to the stomach)

* Previous placental abruption

* Multiple gestations (pregnant with more than one foetus)

* High blood pressure (hypertension), gestational diabetes or pre-eclampsia

* If you smoke or use recreational drugs

* Being older than 40

* Uterine fibroids

* Thrombophilia (a blood-clotting disorder)

* Premature rupture of membranes (your water breaks before the foetus is full-term) or losing too much amniotic fluid

* Chorioamnionitis (an infection in your amniotic fluid)

Complications of

placental abruption

Placental abruption can be life-threatening to the foetus and, sometimes, to the mother. Complications from a placental abruption include:

Foetal complications:

* Premature birth

* Low birth weight

* Growth problems (intrauterine growth restriction)

* Brain injury from lack of oxygen

* Stillbirth

Maternal complications:

* Anaemia

* Blood-clotting issues

* Haemorrhage

* Kidney failure

* Death

Placental abruption can be:

Grade 1: Small amount of bleeding, some uterine contractions and no signs of stress to you or the foetus. This is usually a mild or partial placental abruption, meaning only part of the placenta is detached.

Grade 2: Mild to moderate amount of bleeding, some uterine contractions and possible signs of foetal distress.

Grade 3: Moderate to severe bleeding or concealed bleeding, uterine contractions that don’t relax, abdominal pain, low blood pressure and potential foetal death.

Management

and treatment

Once the placenta has separated from the uterus, it cannot be reconnected or repaired. Generally, the severity of the abruption and gestational age of the foetus are the two most important factors in determining treatment.

A severe abruption is usually a medical emergency because both the foetus and birthing parent are at risk for life-threatening complications. Delivery typically occurs immediately.

The two factors that affect the survival rate are gestational age at birth and the severity of the abruption. Early detection, close monitoring and quick treatment can help reduce complications. If a severe abruption occurs, there’s about a 15 per cent chance it will end in foetal death.

You should contact your healthcare provider immediately if you’re bleeding, cramping or experiencing pelvic pain during your pregnancy, especially in the third trimester.

Placental abruption is a serious condition women can experience during pregnancy. Talk to your healthcare provider if you experience vaginal bleeding, pelvic pain or cramping during pregnancy. They will decide what the next steps are based on the severity of the abruption, the gestational age of the foetus and other factors. Delays in taking appropriate treatment steps may result in foetal death and in some cases foetal and maternal deaths.

Contact Dr Maxwell at 3631807 or 7575411