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Placenta abruptio is a
problem with the placenta during pregnancy. The
placenta is a round, flat organ that forms during
pregnancy to give the baby food and oxygen from the mother. During a normal
pregnancy, the placenta stays firmly attached to the inside wall of the
uterus until the baby has been born. But with placenta
abruptio, the placenta breaks away, or abrupts, from the wall of the uterus too
early, before the baby is born. This problem can cause:
Placenta abruptio can be very harmful for both the mother
and the baby. In rare cases, it can cause death.
See a picture of
Placenta abruptio is also called abruptio
placenta or placental abruption. It affects about 9 out of 1,000 pregnancies.
It usually occurs in the third
trimester, but it can happen at any time after the
20th week of pregnancy.
Doctors aren't sure what causes placenta abruptio. But
there are things that raise a woman’s risk for an abruption. These things are
called risk factors. If you avoid them, you can lower your risk.
Common risk factors for placenta abruptio include:
Less common risk factors for placenta abruptio include:
If you have placenta
abruptio, you may notice one or more warning signs. Call your doctor right away
if you are pregnant and have any of these symptoms:
Call 911 or
emergency services right away if you have:
You can't really tell how serious an abruption is by the
amount of vaginal bleeding. There might be a serious problem even if there is
only a little bleeding. Sometimes the blood can be trapped between the placenta
and the wall of the uterus. In rare cases, symptoms of shock will be the only
signs that there is a problem.
will ask questions about your symptoms and will check your baby’s heart rate.
You may have an
ultrasound test. Your doctor might also do a blood
test to see if you're
anemic from losing blood.
If your doctor
thinks that you have a placental abruption, you'll likely have to stay in the
hospital for at least a few hours. Your doctor will need to find out how severe
the abruption is, if it is getting worse, and if it is affecting your
The kind of treatment you will
have depends on:
If you have a mild abruption, it may get better on its
own. You may just be closely watched for the rest of your pregnancy. You may
not have to stay in the hospital.
A medium to severe abruption
means that you will likely have to stay in the hospital so that the baby's
health can be watched closely. In most cases, the baby will need to be
delivered, sometimes by emergency
Learning about placenta abruptio:
Not every woman with
placenta abruptio has symptoms.
If you have placenta abruptio, you may notice one or more symptoms,
In rare cases, when heavy blood loss is retained in the
uterus behind the placenta, the only signs of placenta abruptio are symptoms of
shock. Early signs of shock (most of which are present at the same time)
High blood pressure (hypertension) is the most common risk
factor associated with placenta abruptio. For more information, see the topic
Preeclampsia and High Blood Pressure During Pregnancy.
A separation of the placenta from
the uterine wall, or
placenta abruptio, can be difficult to identify.
Diagnosis is based on a physical exam, a medical history, and a process of
elimination. Testing may include:
A placenta that has separated from
the uterine wall (placenta abruptio) cannot be repaired. Until its
severity can be assessed, placenta abruptio is considered a medical emergency.
If you have suspected or diagnosed placenta abruptio, you will need to be
observed in the hospital. Some abruptions can get worse quickly and become
life-threatening for both you and your fetus.
If your blood type
Rh-negative and you have placenta abruptio, you will
Rh immune globulin shot, such as RhoGAM. This is because your fetus could be
Rh-positive. Bleeding from an abruption can mix the Rh-positive blood with
yours. The Rh immune globulin prevents your
immune system from attacking the Rh-positive
Placenta abruptio is usually treated by an
If placental separation is
minor, vaginal bleeding is light, and your fetus is not in distress, you may be
observed in the hospital for several hours or several days. For the remainder
of your pregnancy, you'll probably be advised to avoid strenuous activities,
and you and your fetus will need to be monitored regularly.
you are in preterm labor, the separation is minor, and you are far from your
due date, you may be given
tocolytic medicine to stop labor. For more
information, see the topic
separation is moderate to severe, or if it causes a life-threatening condition
disseminated intravascular coagulation (DIC), rapid
delivery is almost always necessary. Although vaginal delivery is sometimes
possible, the need for rapid delivery increases the likelihood of a
cesarean (C-section). In rare cases of heavy bleeding
that won't stop, the uterus is surgically removed (hysterectomy).
Depending on how much blood
you have lost and whether you have disseminated intravascular coagulation, you
may need a transfusion of blood or blood-clotting products, such as
How well your baby does after a placental abruption
depends on how prematurely he or she is delivered and how well the placenta was
able to circulate blood oxygen and nutrients to the fetus before delivery.
Following delivery, it may be necessary to remain close to a
health center able to care for premature infants. A sick or premature newborn
can receive the best treatment possible in a neonatal intensive care unit, or
NICU. Care in the NICU can last days or weeks, depending on the baby's level of
maturity, the extent of the baby's problems, and the amount of care needed. For
more information, see the topic
premature infants can be provided by a
neonatologist, a doctor who specializes in the care of
After having one placental
abruption, you have an increased risk of developing another during a future
pregnancy. After two or more, you have a 1-in-4 risk of having another.2 Although there are no specific treatment guidelines for
preventing another placental abruption, you and your health professional can
take some steps to reduce your risk.
Although most cases of placenta
abruptio cannot be directly prevented, you can avoid or treat factors that are
known to greatly increase your risk of placental abruption.
Even during a healthy pregnancy, placenta abruptio is a
possible complication. But you can optimize your fetus's and your ability to
handle a medical complication by making healthy lifestyle choices and having
regular prenatal checks throughout your pregnancy. For more information, see
Call 911 or other emergency services immediately if you have:
During pregnancy, pay attention to symptoms or injuries
that can be related to the placenta separating from the uterine wall (placenta abruptio). Call your health professional immediately if you are pregnant and you experience:
Should your baby die as a result
of placenta abruptio, allow yourself permission and time to grieve your loss.
Your partner, children, and other family members may also need time to
Contacting a support group, reading about the experiences
of other women, and talking to your doctor, friends, a counselor, or a member
of the clergy may help you and your family deal with your loss. For more
information, see the topic
Grief and Grieving.
If you have plans to become pregnant after having had
placenta abruptio, talk to your health professional ahead of time about
maximizing your chances of a healthy pregnancy in the future.
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care.
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
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
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.
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.
February 3, 2012
Sarah Marshall, MD - Family Medicine & William Gilbert, MD - Maternal and Fetal Medicine
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