Abruptio Placentae Placental abruption

Basic Information

Description

Partial separation of the placenta (also called the afterbirth) from the wall of the uterus in the last 3 months of pregnancy. The placenta carries all nourishment and oxygen to the unborn child. If the placenta partially separates prematurely, the child's life will be endangered. Treatment depends on the severity of the separation, the condition of the fetus, and the duration of the pregnancy.

Frequent signs and symptoms

Small separation of the placenta:

• Vaginal bleeding.
• Mild pain or discomfort.
• Unborn child remains healthy.

Large separation:

• Heavy vaginal bleeding.
• Severe pain in the lower abdomen or back.
• Hard, tender abdomen.
• Shock (rapid heartbeat, rapid breathing and dizziness).
• Fetal distress; heartbeat of the unborn child may be inaudible.
• Coagulopathy (disseminated intravascular coagulopathy [DIC])-certain elements of the placenta are released into the mother's circulation causing blood clotting defects.
• Symptoms can include nosebleed, blood in the urine, oozing from the puncture sites, bleeding into the skin, round red spots on the skin.

Causes

Unknown.

Risk increases with

• High blood pressure (hypertension).
• Women who smoke.
• Women over age 35.
• Women who have had several pregnancies.
• A previous pregnancy with placental separation.
• A direct blow to the uterus.
• Chronic disease such as diabetes mellitus.
• Abuse of alcohol or drugs (particularly cocaine).
• Rectal thermometers or enema nozzles.

Preventive measures

• If pregnant, don't engage in activity more vigorous than what you were accustomed to before pregnancy.
• Avoid risk factors when possible.
• Since the cause is unknown, there is no assured way to prevent the problem.

Expected outcomes

When the separation is less severe, and with immediate medical care, the outlook for mother and fetus is good.

Possible complications

• Shock or life-threatening bleeding in the mother.
• Death of unborn child and mother.
• Brain damage to the unborn child.
• 10 to 17% of patients have abruptio placentae in a future pregnancy.

Treatment

General measures

• Abruptio placentae is an emergency, but there is usually time to obtain advice by telephone and arrange safe transportation to the hospital. Panic is not helpful. If the placenta separation is slight, you may be able to return home for bed rest and close observation after examination.
• Hospitalization required (except for mild cases).
• Surgery to deliver the unborn child by cesarean section or vaginal delivery (sometimes).

Medications

• Oxytocin to induce labor, if immediate delivery is necessary.
• Intravenous fluids may be necessary.
• Blood transfusions may be necessary to replace amount of blood lost.

Activity

If you are able to remain at home, rest in bed until bleeding and other symptoms cease. Do not resume normal activities until specific instructions to do so are given to you.

Diet

• If you are resting at home, continue with your regular diet.
• If hospitalized, a liquid-only diet may be prescribed until it is determined that surgery is not likely. Solid food may lead to complications if emergency surgery becomes necessary.

Last updated 13 June 2015