Placental Abruption

Placental abruption usually occurs suddenly, and mostly during the last stages of the pregnancy or a few weeks before the delivery date. Placental abruption during labour is also possible and can necessitate an emergency C-section.

The symptoms of placental abruption may coincide with other complications, so you should visit a doctor immediately if you notice any of these signs. You might experience the following symptoms in case placental abruption happens:

• Vaginal bleeding: Most women who have placental abruption experience this, though in some cases the blood can remain trapped in the uterus and there might be no visible bleeding. The amount of placenta detached from the uterine wall does not directly correspond with the amount of bleeding.

Chronic placental abruption proceeds at a slower pace than sudden abruption. A mom-to-be who has this condition may notice periodic vaginal bleeding.

• Abdominal and back pain: These usually show up suddenly and can be quite acute. They are some of the most indicative symptoms of placental abruption. You may also experience some tightness or firmness in the stomach.
• Uterine tenderness and contractions: Your uterus might feel tender and you might experience uterine contractions. These contractions are usually very rapid, signalling the severity of the situation.
• Foetal heart rate abnormalities: Since the placenta is meant to supply oxygen to your foetus, any abnormalities in the foetus’ heart rate, especially ones that are showing up frequently, might be due to placental abruption.

If you have any of these symptoms, you should consult your doctor immediately and head to the hospital.

Placental abruption can occur due to the following reasons:

• Trauma to the uterus, like in a car accident
• Uterine abnormalities
• Uterine infection (chorioamnionitis)
• Rapid loss of amniotic fluid

Further, there are some factors that can increase the risk of placental abruption in moms-to-be:

• Being pregnant with twins or multiple foetuses in your womb
• High blood pressure
• Preeclampsia, which affects 8-10% of pregnant women in India, is marked by high blood pressure and signs of damage to the liver and kidneys. If left untreated, it can be fatal.
• Getting pregnant at an older age; above 35 years
• Smoking or substance abuse, like cocaine consumption
• Placental abruption in your first pregnancy may put you at greater risk in your second pregnancy.

Placental abruption is usually diagnosed through ultrasound and a proper evaluation of the symptoms. The attending doctor may also recommend foetal monitoring, a blood test and a urine test. Depending on the severity of the situation, your doctor might decide to perform a C-section or Cesarean to deliver the baby prematurely but safely.

All cases of placental abruption need to be constantly monitored to ensure the safety of the mother and baby. This constant monitoring of vital signs can be best accomplished in a hospital, so if you do show symptoms of placental abruption, you should consult your doctor and be hospitalised immediately - until both you and your baby are deemed safe. The treatment of placental abruption depends on the severity of individual cases.

• Mild cases: This is more likely to happen earlier in the pregnancy. If the vaginal bleeding stops and your baby is declared safe, you will be able to go home to complete the remaining gestation period. However, it is important to be vigilant and contact your doctor or head to the emergency room if the symptoms show up again.
• Moderate cases: This is more likely to happen later in the pregnancy. If your condition is not deemed safe enough to finish the gestational period at home, then your doctor will keep you and the baby under medical surveillance in the hospital until the baby has grown big enough to be delivered safely. The doctor might give medications to quicken the organ growth, especially for the baby’s lungs, and then medically induce labour to ensure safe delivery.
• Late pregnancy cases: If placental abruption happens after 36 weeks of pregnancy, then the doctor will recommend immediate delivery because the baby is mature enough to survive post-delivery at this stage. Vaginal delivery might be induced, but if there are further complications, then the doctor will likely perform a Cesarean delivery. Placental abruption can also occur during labour, which necessitates an emergency C-section.
• Severe cases: Irrespective of the gestational stage, a severe case will have to be treated with immediate delivery of the baby. The mother usually requires supportive care, like blood transfusions, in this treatment, and it can also lead to a hysterectomy if the situation is too dire.

Preventing placental abruption is next to impossible, but you can reduce the risk factors by ensuring the following:

• Do not smoke, or use illegal drugs like cocaine before or during your pregnancy.
• If you have high blood pressure and blood sugar imbalances, then it’s best to monitor yourself regularly for signs of placental abruption. Your doctor might call you for more routine health checks if you are diagnosed.
• Protect your abdomen from sudden trauma or shocks. Wear seat belts when in an automobile. If your abdomen has received any trauma at all, you should head to the emergency room and get yourself and the baby checked out immediately.
• If you’ve experienced placental abruption in a previous pregnancy, then you should discuss the risk of developing it in any future pregnancy with your doctor. The doctor will be able to further guide you through preventive care measures if you are in the higher risk category.

It is important that you don’t ignore the signs of placental abruption and get immediate help because it can cause irreparable damage and complications for both mother and baby.

For the mother, placental abruption can lead to the following:

• Blood loss, resulting in organ failure and shock
• Disseminated intravascular coagulation or blood clotting issues
• When uterine bleeding cannot be controlled, a hysterectomy, or surgery to remove the uterus, may be needed.

For the baby, placental abruption can lead to the following:

• Restricted growth due to lack of nutrients and oxygen
• Premature birth
• Stillbirth