What is abruptio placenta?
Abruptio placenta is a pregnancy problem in which the placenta separates too early from the wall of the uterus. The placenta is a round, flat organ that forms during pregnancy. It gives the baby food and oxygen from the mother.
- In a normal pregnancy, the placenta stays firmly attached to the inside wall of the uterus until after the baby is born.
- In abruptio placenta, the placenta breaks away (abrupts) from the wall of the uterus too early, before the baby is born.
Abruptio placenta can be very harmful. In rare cases, it can be deadly.
- The baby may be born too early (premature) or at a low birth weight.
- The mother may lose a lot of blood.
Abruptio placenta usually occurs in the third trimester. But it can happen at any time after the 20th week of pregnancy. It is also called placenta abruptio or placental abruption.
What causes abruptio placenta?
Doctors aren't sure what causes it, but some things can raise your risk. These are called risk factors. Common risk factors for abruptio placenta include:
- High blood pressure. This is the biggest risk factor for abruptio placenta, whether the high blood pressure is a long-term problem or is caused by the pregnancy (pre-eclampsia).
- Having had abruptio placenta before.
- Smoking during pregnancy.
Less common risk factors include:
- Using cocaine.
- Having a scar from a past surgery or a uterine fibroid where the placenta has attached to the wall of the uterus.
- Having an injury to the uterus. This could occur because of a car crash, a fall, or physical abuse.
- Premature rupture of membranes for 24 hours or more, especially when there is an infection in the uterus.
What are the symptoms?
If you have abruptio placenta, you may notice one or more warning signs. Call your doctor or nurse call line right away if you are pregnant and you:
- Have light to moderate bleeding from your vagina.
- Have a painful or sore uterus. It might also feel hard or rigid.
- Have signs of early labour. These include regular contractions and aches or pains in your lower back or belly.
- Notice that your baby is moving less than usual.
You can't really tell how serious abruptio placenta is by the amount of vaginal bleeding. Sometimes the blood gets trapped between the placenta and the wall of the uterus. So there might be a serious problem even if there is only a little bleeding.
Call 911 or emergency services right away if you have:
- Sudden or severe pain in your belly.
- Severe vaginal bleeding, such as a gush of blood or passing a clot.
- Any symptoms of shock. These include feeling light-headed or like you are going faint; feeling confused, restless, or weak; feeling sick to your stomach or vomiting; and having fast, shallow breathing.
In rare cases, symptoms of shock are the only signs of a serious problem.
How is abruptio placenta diagnosed?
This problem can be hard to diagnose. Your doctor will ask questions about your symptoms and do a physical examination. Tests that may be done include:
- Fetal heart monitoring. This is to assess your baby's condition and check for contractions of the uterus.
- An ultrasound. This test can detect about half of placental abruptions.
- A blood test for anemia. You can become anemic from heavy blood loss.
If abruptio placenta is suspected, you'll probably need to be in the hospital until your doctor finds out how severe it is.
How is it treated?
The kind of treatment you need will depend on:
- How severe the abruption is.
- How it is affecting your baby.
- How close your due date is.
If you have mild abruptio placenta and your baby is not in distress, you may not have to stay in the hospital.
- You and your baby will be checked often throughout the rest of your pregnancy.
- If you are in preterm labour and are far from your due date, you may be given medicine to stop labour.
If you have moderate to severe abruptio placenta, you will probably have to stay in the hospital so your baby's health can be watched closely.
- In most cases, the baby will need to be delivered quickly. This means you are likely to have a C-section (caesarean delivery).
- If you have lost a lot of blood, you may need a blood transfusion.
If your baby is premature, he or she may be treated in a neonatal intensive care unit, or NICU. The NICU is geared to the needs of premature or ill newborns.
Can you prevent abruptio placenta?
There is no sure way to prevent abruptio placenta, but you can do things to lower your risk. Your risk is much higher than normal if you have had abruptio placenta before, so these steps are very important.
- If you have high blood pressure, follow your doctor's treatment advice.
- Don't smoke while you're pregnant.
- Don't use illegal drugs, like cocaine and meth.
- Get regular prenatal checkups throughout your pregnancy.
- Take at least 400 mcg of folic acid every day for at least 2 to 3 months before trying to get pregnant and while you are pregnant.footnote 1 Some women need higher doses. Talk with your doctor or midwife about how much folic acid you need. Follow your doctor's advice about how to get higher amounts of folic acid. Don't just take more multivitamins. You could get too much of the other substances that are in the multivitamin.
Frequently Asked Questions
Learning about abruptio placenta:
- Wilson RD, et al. (2015). Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies. SOGC Clinical Practice Guideline No. 324. Journal of Obstetrics and Gynaecology Canada 37(6): 534–549. http://sogc.org/wp-content/uploads/2015/06/gui324CPG1505E.pdf. Accessed July 20, 2015.
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.
- 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.
- 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
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer William Gilbert, MD - Maternal and Fetal Medicine
Rebecca Sue Uranga, MD - Obstetrics and Gynecology
Current as ofJanuary 16, 2018
Current as of: January 16, 2018