For most women, the placenta is a part of pregnancy that doesn’t get much thought. The organ that supports the life of the fetus typically develops alongside it and then is delivered about 30 minutes after the baby is born. But rarely—in less than one percent of pregnancies—a serious complication called placental abruption occurs.
Placental abruption is when the placenta partially or completely separates from the uterine wall, in some cases leading to heavy bleeding for the mom and nutrient and oxygen deprivation for the baby.
The cause of abruptions isn’t entirely understood, but there are factors that put some women more at risk, says Andrea Neilson, an OB/GYN from the Women’s Health Clinic of Edmonton. Risk factors include illicit drug use, smoking during pregnancy and high blood pressure. A sudden impact, like falling or being in a car accident, can also lead to an abruption.
Most placental abruptions are partial and therefore less serious. Still, a partially detached placenta can mean less oxygen and nutrients are flowing to the growing fetus. If the placenta becomes partially detached close to the due date, the baby is often delivered via C-section. If it happens earlier in the pregnancy, doctors will watch the baby’s development and the mother’s health closely through ultrasounds. In most cases, with proper monitoring, a baby will survive a partial placental abruption.
But when the placenta completely detaches from the uterus, “The baby has no means of supporting itself in terms of oxygenation or getting any nutrients,” says Neilson, adding that an emergency delivery, often by C-section, is necessary to save the baby’s life. “It’s an extremely serious condition and it can be life-threatening to both the mom and the baby.” About half of all abruptions happen before 37 weeks, with about 14 percent occurring before 32 weeks.
The biggest risk to the mother, when the placenta detaches completely is the possibility of hemorrhaging or excessive internal bleeding.
Although abruptions are rare, Neilson says it’s important to have any vaginal bleeding in the second and third trimesters investigated immediately. Other signs of abruption include a hard or painful uterus, severe abdominal or back pain, and continuous sudden contractions before your baby is full-term.
Melissa Dean, a midwife and the founder of Casa Nata Birth and Wellness Center in the San Francisco Bay Area, explains that there are different levels of placental abruption, each with varying symptoms.
According to Dean, "Marginal abruption refers to a separation at the edge of the placenta, which is noted by vaginal bleeding." She also notes that "Concealed abruption is the separation of the center of the placenta, with bleeding being concealed, and symptoms would include acute centrally located abdominal pain distinct from uterine contractions."
Finally, Dean suggests that "complete abruption refers to the total separation of the placenta from the uterine wall, and symptoms would include heavy vaginal bleeding possibly with accompanying clots."
In case you experience any symptoms associated with placental abruption or have vaginal bleeding, Dean advises that you call your provider immediately. She stresses the importance of seeking prompt medical attention if you experience any of these symptoms, as untreated placental abruption can put both the mother and the baby at risk.
Dean states that placental abruption is generally diagnosed using an ultrasound. However, if there is severe bradycardia during labor, it can lead to an emergency cesarean. “During the cesarean, the abruption is then diagnosed at the same time as the operation,” adds Dean.
Although placental abruption is rare and often occurs without warning or a known cause, Dean states that preeclampsia, a condition that develops during pregnancy and results in high blood pressure and high levels of protein in the urine of the pregnant mother, can result in an eight percent increase in abruption.
To minimize the risk of developing preeclampsia, Dean recommends controlling high blood pressure and closely monitoring the placenta throughout pregnancy. “Avoiding substances such as alcohol, cigarettes, and any unprescribed drugs is also essential to maintaining a healthy pregnancy,” adds Dean.
If abruption happens and is promptly treated, Dean suggests that the baby has a high likelihood of survival. However, if the mother is not treated immediately, the placental abruption can be fatal. In addition, if a complete abruption occurs outside the hospital during late pregnancy or early labor, Dean says it can also prove fatal to the baby.
Dean explains that if hypoxia, a condition defined by low levels of oxygen in the body tissues, takes place before birth, it can influence the development of a newborn. “Because the placenta is essential for providing oxygen to the fetus, it has an important function in early development,” she adds.
If there is a suspected abruption, Dean says the birth will in all likelihood be a cesarean. Yet, if the rupture occurs just as the birth is about to happen, she suggests that the baby may be born vaginally. “The outcome depends on the timing,” adds Dean.
Due to the fetus receiving oxygen through the placenta, Dean suggests that the separation of the placenta before birth can lead to stillbirth, as it disconnects the oxygen supply to the fetus. That's why it's vital to be mindful of any concerning symptoms, as unmanaged placental abruption can jeopardize both the mother and the baby.
As abruption can occur at any time during pregnancy, Dean says it can cause premature birth as an effort to save the fetus.
“Women of color, those with poor nutritional habits,and inadequate prenatal care are more susceptible to hypertension, preeclampsia, and placental abruption,” says Dean. “Therefore, seeking guidance from a doctor or OB/GYN is crucial to ensure a safe and healthy pregnancy.”
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