Placenta Abruptio is premature detachment of the placenta, either fully or partially, from the walls of the uterus, before the baby is delivered.
What are the other Names for this Condition? (also known as/Synonyms)
- Abruptio Placentae
- Placental Abruption
- Premature Separation of Placenta
What is Placenta Abruptio? (Definition/Background Information)
- Placenta Abruptio is premature detachment of the placenta, either fully or partially, from the walls of the uterus, before the baby is delivered
- When a premature separation of the placenta occurs, the supply of oxygen and other vital nutrients to the fetus may be affected. This can lead to fetal and maternal death (death of both the fetus and the mother)
- In some instances, the condition may be confined to a segment of the uterus and is referred to as a concealed hemorrhage
- Indications that a Placenta Abruptio may have occurred include vaginal bleeding, uterine tenderness, abdominal pain, abnormal contractions, and fetal distress
- The separation of the placenta may be either partial or complete, and this can affect the recommended treatment measures. The prognosis depends on the degree and severity of Placenta Abruptio
Who gets Placenta Abruptio? (Age and Sex Distribution)
- Placenta Abruptio occurs in 0.5-1.5% of pregnancies (i.e. 1 in 70-200)
- Women of advanced maternal age (defined as over 35 years of age), are at a greater risk
- All races and ethnic groups can be affected
What are the Risk Factors for Placenta Abruptio? (Predisposing Factors)
Risk factors for Placenta Abruptio include:
- Placental Abruptio during a past pregnancy, predisposes one to recurrence of the condition in future pregnancies
- High blood pressure (hypertension) in the pregnant woman; known as eclampsia or preeclampsia
- Any type of trauma or accident, including motor vehicle accidents, abdominal trauma, or a fall
- Use of cocaine, cigarette smoking, or heavy alcohol use during pregnancy
- Premature rupture of the amniotic sac, due to breakage or leakage
- Collagen vascular disease, blood clotting disorders, uterine fibroids, uncontrolled diabetes mellitus, and vascular diseases, may predispose one to Placenta Abruptio
- Multiple pregnancy, a pregnancy with two or more fetuses (multiparous pregnancy causing Placental Abruption)
- Advanced maternal age, greater than 35 years
- Uncontrolled diabetes: Diabetic individuals carry a high percentage of risk
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Placenta Abruptio? (Etiology)
Premature detachment of the placenta, either fully or partially from the walls of the uterus, prior to delivery of the baby is called Placenta Abruptio. The causal factors for this abnormality may include:
- Physical trauma, such as motor vehicle accidents, abdominal trauma, or a fall
- Sudden loss of amniotic fluid
- Delivery of twins in the first pregnancy
- Rupture of the membranes - rupture of either the amniotic sac or chorion
What are the Signs and Symptoms of Placenta Abruptio?
The signs and symptoms of Placenta Abruptio may include:
- Vaginal bleeding
- Abdominal pain
- Back pain
- Frequent contractions of the uterus
- Tenderness of the uterus
- Fetal distress or signs that the fetus may not be doing well
How is Placenta Abruptio Diagnosed?
Placenta Abruptio is diagnosed using the following tools:
- Physical examination to evaluate for vaginal bleeding, uterine tenderness, and rigidity
- Evaluation of medical history
- Fetal monitoring to assess the fetal heart and for any lack of oxygen
- Abdominal or vaginal ultrasound scan, wherein sound waves are used to create an image of the uterus on a monitor screen
- Complete blood count, fibrinogen level, and other blood tests
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Placenta Abruptio?
Placenta Abruptio can lead to complications, both for the mother and the fetus.
Maternal complications include:
- Blood-clotting problems, such as disseminated intravascular coagulation (DIC)
- Blood loss: Uncontrollable blood loss may necessitate a hysterectomy (surgical procedure to remove the uterus)
- Need for blood transfusion
- Excess loss of blood may sometimes lead to the death of the mother
- Kidney failure; failure of other organs
Complications to the fetus:
- Reduced oxygen and nutrient supply required for survival
- Preterm delivery
How is Placenta Abruptio Treated?
A treatment of Placenta Abruptio involves the following:
- Fluid administration through the veins
- Blood transfusion
- Cesarean operation (C-section) may be required, as opposed to a vaginal delivery
- RhoGAM is often administered to Rh-negative women
- In preterm pregnancies, medications may be given to assist the fetus in maturing
How can Placenta Abruptio be Prevented?
A few preventive measures of Placenta Abruptio include:
- The avoidance of cigarettes, illegal drugs, and heavy alcohol use
- Controlling high blood pressure and diabetes
- The use of seat belts to protect the abdomen from accidents, so as to reduce the risk of any injury
- Seek out prenatal care by a healthcare provider, in order to completely monitor the course of the pregnancy
- If there is history of Placenta Abruptio, a discussion with your healthcare provider before conceiving again, is recommended
What is the Prognosis of Placenta Abruptio? (Outcomes/Resolutions)
The prognosis of Placenta Abruptio varies and they depend on:
- The severity of the abruption - partial versus complete, as well as the amount of blood loss incurred
- Timely medical attention
- The prognosis of Placenta Abruptio is usually good with prompt treatment.
The mortality rate of the mother from Placenta Abruptio is less, compared to that of the fetus; fetal mortality may be up to 35%. In cases of delayed medical treatment, the mortality rate for both the mother and the fetus increases dramatically.
Additional and Relevant Useful Information for Placenta Abruptio:
The following DoveMed website link is a useful resource for additional information:
What are some Useful Resources for Additional Information?
American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC 20024-2188
Phone: (202) 638-5577
Toll-Free: (800) 673-8444
References and Information Sources used for the Article:
http://trihealth.adam.com/content.aspx?productId=14&pid=14&gid=000127 (accessed on 05/28/2014)
http://www.mayoclinic.com/health/placental-abruption/DS00623/DSECTION=risk-factors (accessed on 05/28/2014)
Helpful Peer-Reviewed Medical Articles:
Baron, F., & Hill, W. C. (1998). Placenta previa, placenta abruptio. Clinical obstetrics and gynecology, 41(3), 527-532.
Johnson, J. F., Seegers, W. H., & Braden, R. G. (1952). Plasma Ac-globulin changes in placenta abruptio. Obstetrical & Gynecological Survey, 7(4), 504-505.
Hartmann, W., & Rawlins, C. M. (1960). Hypnosis in the management of a case of placenta abruptio. International Journal of Clinical and Experimental Hypnosis, 8(2), 103-107.
Anderson, J. H., FORD, B., Fischer, P., & LINE, S. (1984, January). PLACENTA ABRUPTIO IN CAPTIVE NONHUMAN-PRIMATES. In INTERNATIONAL JOURNAL OF PRIMATOLOGY (Vol. 5, No. 4, pp. 320-320). 233 SPRING ST, NEW YORK, NY 10013: PLENUM PUBL CORP.
Combs, C. A., Njberg, D. A., Mack, L. A., & Smith, J. R. 8enedetti CJ (1992) Expectant management after sonographie diagnosis of placenta abruptio. Am J Perinatal, 9, 170-174.
Cukierski, M. A., Anderson, J. H., & Ford, E. W. (1985). Premature separation of the normally implanted placenta (abruptio placentae) in nonhuman primates. Abstr., In. Anat. Cong., 12th.
Wandabwa, J., Doyle, P., Paul, K., Wandabwa, M. A., & Aziga, F. (2005). Risk factors for severe abruptio placenta in Mulago Hospital, Kampala, Uganda. African health sciences, 5(4), 285-290.
Scheneider, C. L. (1951). Fibrin embolism (disseminated intravascular coagulation) with defibrination as one the end results during placenta abruptio. Surg Gynecol Obstet, 92, 27-34.