Maternal and Infant Health Program Maternal and Infant Health Program

Phone:
  SLC area: (801) 538-9970

FAX:
  SLC area: (801) 538-9409

Mail:
Maternal and Infant Health Program
  P.O. Box 142001
  Salt Lake City UT
  84112-2001




What is Placental Abruption?

Placental abruption is the early separation of the placenta (afterbirth) from the wall of the uterus (womb). The placenta is an organ that grows inside the uterus during pregnancy to provide food and oxygen to the baby. Separation of the placenta before delivery occurs in about one in 120 births. It can occur any time after about the twentieth week of pregnancy, and occurs more often in the last three months.

Normally the placenta does not separate from the uterus until right after the birth of the baby. When placental abruption occurs, the placenta starts to come away from the uterus before the baby is born. This can cause serious problems for the baby and mother.

You are at a higher risk for placental abruption if you:

  • Smoke cigarettes
  • Are 35 years of age or older
  • Have had more than 4 or 5 children
  • Are pregnant with twins or triplets
  • Have high blood pressure
  • Use cocaine or other illegal drugs
  • Have diabetes
  • Have had a previous abruption
  • Have trauma to the uterus such as a car accident or a fall
  • Have certain blood clotting disorders
  • Bag of water breaks early in the pregnancy

The symptoms of placental abruption may include:

  • Contractions (tightening of the uterus) that don’t stop
  • Severe back or abdominal pain
  • Tenderness in the abdomen over the uterus
  • Vaginal bleeding (sometimes)

How is it diagnosed?

The doctor or midwife will give you a physical exam, looking for signs of blood loss. These tests may be done:

  • Blood tests
  • Ultrasound scan to look for a blood clot behind the placenta
  • Fetal monitoring to check the baby’s heart rate and look for signs of distress in the baby

The abruption may be described as a Grade 1 (mild), Grade 2 (mild to moderate), or Grade 3 (moderate to severe).

How is it treated?

This will depend on many things such as:

  • How much of the placenta has separated from the uterus
  • How close the pregnancy is to full term (37 weeks or more)
  • Your health and whether you have other problems, such a high blood pressure
  • The amount of blood you have lost
  • The baby’s health

If the separation of the placenta is small, the baby isn’t in distress, and your condition is stable, you may be able to go home and continue the pregnancy with frequent checkups. You may be advised to avoid sexual activity and some forms of physical activity.

If you are admitted to the hospital, you will be given intravenous (IV) fluids. A fetal monitor will be used to check the baby for signs of distress.  Your blood pressure, pulse, and amount of bleeding will be closely checked. Blood tests will be doneto check your iron level and blood clotting factors.

If the separation is moderate, the baby is not in distress and your condition is stable, the doctor may induce labor and perform a vaginal delivery. If the baby is in distress or if you are losing a lot of blood, the doctor will deliver the baby immediately by cesarean section.

There is no treatment to stop the placenta from separating or to re-attach it. The baby can survive when even up to one half of the placenta is separated from the uterus.

What are the effects?

Sometimes the separation and bleeding begins and then stops without treatment. As long as you and the baby are healthy, your pregnancy can continue with frequent checkups. A mild case will probably have no long-term effects on your health or your baby’s health.

A moderate to severe separation of the placenta may have the following effects:

  • A large blood loss may require blood transfusions and intensive care after delivery for the mother
  • The baby may be in distress until delivery and may need to be born prematurely. They may have problems with breathing and feeding. In severe cases the baby could have permanent problems or be stillborn.

The good news is that with quick attention and expert care, nearly all mothers and their babies survive.

Helping to prevent placental abruption

Good prenatal care (beginning in the first thirteen weeks and continuing with regular visits) and a healthy diet may reduce the risk of high blood pressure during pregnancy. Prevention of high blood pressure decreases the risk of abruption.

If you smoke, decreasing the number of cigarettes and stopping smoking will decrease your risks of having a placental abruption.

Always use a seat belt in the car to minimize any potential trauma from a car accident.  If an accident does occur, or if you have a fall, either call your provider or go to the hospital for further monitoring. 

Abruption caused by the use of cocaine or amphetamines can be prevented if the mother stops using these drugs.

If you have had a placental abruption with a previous pregnancy and are pregnant again, be sure to report this to your care provider and immediately report any contractions or bleeding you might experience.

If you have further questions about placental abruption, contact your doctor or midwife. This pamphlet is for informational purposes only, and should not replace the advice of a care provider.