Complete Or Total Placental Abruption

Are you pregnant but still observing spots in your panties? If yes, then you surely need to check with your gynaecologist. Such bleeding is uncommon during pregnancy and may be harmful to you and your baby. This condition is called placental abruption and occurs only in 1% of  pregnancies.¹ Placental abruption is the leading cause of vaginal bleeding in the 3^rd trimester. 

What is placental abruption?

Placental abruption is a pregnancy complication that occurs when the placenta (entirely or partially) detaches from the inner wall of the uterus before childbirth.

The placenta is a temporary organ that develops in the uterus during pregnancy and connects the growing foetus and the uterus. The placenta connects to the uterine wall when positioned on the top or side of the uterus. It is a vital source of nutrients and oxygen to the developing foetus through the umbilical cord. So, the placental abruption can deprive the baby of oxygen and nutrients and can endanger the lives of the mother and the baby. Placental abruption may cause heavy bleeding, so  premature delivery may be required.

What is a placenta?

The placenta² is an essential organ that performs various physiological, immunological, and endocrine functions. Its development is gradual and occurs over the first three months of pregnancy. However, after the fourth month, it starts to grow in sync with the development of uterus. Upon completion, the placenta takes the shape of a disc that is spongy in texture, measuring 20 cm in diameter and 3 cm in thickness. 

The placenta, a temporary organ, shares the same genetic characteristics as the developing child. The placenta and its surrounding environment interact with each other. A successful pregnancy heavily relies on the proper development of the placenta. Proper development of the delicate organ during gestation requires the average growth and formation of several layers of tissue. The pregnancy can have devastating consequences if there is a lack of proper function.

Symptoms of placental abruption

Symptoms of placental abruption include: 

• Vaginal bleeding
• Lower abdominal pain
• Low blood pressure
• Uterine stiffness
• Frequent uterine contractions 
• Less movement of the foetus
• Back pain

Vaginal bleeding is not a reliable indicator of the severity of the abruption and might vary. Sometimes, the blood becomes trapped between the uterine wall and the placenta, which prevents noticeable bleeding. Pain can vary significantly from little cramps to powerful, unexpected contractions.³

There are additional pregnancy issues that these symptoms may mimic. Always get in touch with your pregnancy care provider if you experience  cramps and vaginal bleeding.

Types of placental abruption

Placental abruption can be divided into two main categories, depending on how much the placenta has detached from the uterine wall.

• Partial placental abruption 

In a partial placental abruption, the placenta remains partially attached to the uterine wall instead of entirely detached.

• Complete placental abruption 

In the case of a complete or total placental abruption, the placenta separates from the uterine wall. When there is a complete abruption, there is typically increased vaginal bleeding

Placental Abruption can be further classified based on bleeding

• Revealed placental abruptions 

Placental abruptions that are revealed typically present with noticeable vaginal bleeding ranging from moderate to severe.

• Concealed placental abruptions 

Vaginal bleeding is either minimal or absent in cases of concealed placental abruptions. When blood gets trapped between the placenta and the uterine wall, it can cause complications.

Aetiology 

Although the exact cause of placental abruption is not known, several risk factors⁴ have been identified, some of which are:

• Maternal hypertension (44% of the cases)
• Accident or blow to the abdomen⁴
• Placental abruption in previous pregnancy⁴
• Smoking⁴
• Alcohol consumption⁴
• Short umbilical cord
• Maternal age (>20 or <35)
• Subchorionic hematoma⁵
• Thrombophilia
• Premature membrane rupture

Complications of placental abruption

Placental abruption may be a life-threatening condition for the foetus and the birthing parent. Some  complications of placental abruption for the birthing parent may be:

• Shock because of  excessive blood loss
• Blood clotting issues
• Blood transfusion
• Renal or other organ failure brought on by blood loss
• In rare cases, a hysterectomy may be necessary if uterine bleeding cannot be stopped

For the baby, placental abruption may causes: 

• Low birth weight
• Intrauterine growth restrictions
• Premature birth
• Stillbirth
• Brain injury due to the lack of oxygen

Diagnosis and treatment

Diagnosis of placental abruption

If placental abruption is suspected, the healthcare provider first performs a physical examination to check for uterine stiffness or tenderness. To  identify potential causes of vaginal bleeding, your healthcare provider will probably suggest conducting blood and urine tests and  an ultrasound.

If the bleeding increases , the birthing parent may be admitted to the hospital for further examinations.

Treatment of placental abruption

The placenta cannot be fixed or reattached once it has detached from the uterus. A medical professional will suggest an approach depending on the following factors:

• The amount of blood loss by the birthing parent
• Gestational age
• The severity of the abruption
• Signs of distress from the foetus

The two most crucial variables in deciding on a course of therapy are often the foetus's gestational age and the severity of the abruption.

Management with less gestational age

If the gestational age is less (>37 weeks) and the abruption is mild, the healthcare provider may put the birthing parent on bed rest and monitor her closely. The provider may also prescribe corticosteroids to help the foetal lungs mature.

However, if  the abruption is severe, and the life of the foetus or the birthing parent is at risk. In that case, immediate delivery is performed despite the  gestational age (>37 weeks of pregnancy).

Management near term (<37 weeks)

If the abruption is moderate and the foetal heart rate is average, the healthcare professional may decide to let the pregnancy continue to term. Corticosteroids may help the foetus' lungs grow, and any changes will be closely observed.

When the abruption is severe, an urgent delivery may be necessary. At any point, if the birthing parent or the foetus is in danger, the baby will be delivered (usually by emergency caesarean section).

Regardless of the foetal age, delivery is performed if anything of the following happens:

• Placental abruption is getting worse
• Heavy bleeding or severe anaemia
• Oxygen deficiency of the foetus

Prevention 

Placental abruption cannot be avoided; however, some risk factors can be reduced. Do not  take cocaine or other illicit substancesor smoke. Collaborate with your physician to monitor your blood pressure if it is elevated.

Always buckle up when in a motor vehicle. Seek emergency medical attention if you have suffered abdominal damage from a fall, car accident, or other injury.

Whether you have previously had a placental abruption and are considering becoming pregnant again, consult your doctor before getting pregnant to find out whether there are any preventative measures you can take.

FAQs

How do you fix placental abruption?

If the placenta starts separating from the uterus before the baby is born, it is called placental abruption. A medical problem or physical trauma can cause it. It quickly becomes life‐threatening for women and babies and cannot be repaired.⁶

Can ultrasound detect placental abruption?

The sensitivity of an ultrasound examination in detecting placental abruption is as low as 25%.⁷

How painful is placental abruption?

During a placental abruption, you may experience sudden or sharp pain, cramping or tenderness in your lower pelvic region or back. You could also feel the foetus move less. Discuss these symptoms with your pregnancy care provider immediately.

What is the number 1 risk factor for placental abruption?

Factors that can be identified during the health history that increase the risk of placental abruption include smoking, cocaine use during pregnancy, maternal age over 35 years, hypertension, and placental abruption in a prior pregnancy.⁸

Does sleeping position affect the placenta?

Women who usually slept supine at conception and implantation were significantly more likely to have a high or fundal placental location than those who usually slept in the prone position (p = 0.041).⁹

Summary

Placental abruption, a severe complication of pregnancy, occurs when the placenta detaches from the uterine wall before childbirth. It poses risks to both the mother and the baby, including heavy bleeding and oxygen deprivation. Symptoms include vaginal bleeding, abdominal pain, and decreased foetal movement. 

Placental abruption can be partial or complete, with varying degrees of bleeding. While the exact cause is unknown, risk factors include maternal hypertension, trauma, and substance use. 

Diagnosis involves physical examination, blood tests, and ultrasound. Treatment depends on the severity and gestational age, ranging from close monitoring to emergency delivery. Prevention consists of  avoiding risk factors and seeking medical attention for trauma. Early detection and management are crucial for ensuring the best outcomes for both mothers and babies.