Partial Placental Abruption

Overview

The uterus is a pear-shaped organ found in the reproductive system of females at birth (AFAB). It is a hollow structure between the rectum and the bladder¹ responsible for menstruation, fertility and pregnancy. The placenta forms during pregnancy and attaches to the uterine wall, which provides nutrients and oxygen to the baby through the umbilical cord.² The placenta removes waste products from the foetal blood and connects the foetus to the mother’s uterus.

Partial placental abruption is a condition that occurs during pregnancy where the placenta partially separates from the uterus causing bleeding, abdominal pain and complications during pregnancy and delivery. This condition is a serious complication that can cause a decrease in oxygen and nutrient levels in the foetus.³ Placental abruption can cause early delivery in some cases and if left untreated, can endanger both the mother and baby's life.²

Types of placental abruption

Partial placental abruption

Partial placental abruption is the condition where the placenta detaches from the uterus partially from the uterine wall causing minimal bleeding and abdominal pain.

Complete placental abruption

Complete placental abruption is the condition where the placenta detaches completely from the uterine wall leading to excessive vaginal bleeding and increased chances of early delivery.

Risk factors

• Trauma or injury (accident or fall) to the uterus increases the chance of placental abruption
• Previous multiple pregnancies
• Previous placental abruption or placenta previa⁸
• History of high blood pressure or diabetes
• Drugs or smoking use
• Getting pregnant after the age of 40
• Having previous uterine surgery for uterine fibroids
• Early rupture of the membranes causing leakage of amniotic fluid before the due date
• Chorioamnionitis: It is a serious bacterial infection affecting the membrane surrounding the foetus and the amniotic fluid⁹

Causes

The exact cause of partial placental abruption is unknown. The possible risks which may cause placental abruption are:

• Trauma or injury to the abdomen: Trauma may tear the placenta away from the uterus. An injury from a car accident, assault or fall can affect the placenta by detaching away from the wall of the uterus
• Decrease in fluid (amniotic fluid): Sudden loss of amniotic fluid can cause partial placental abruption. Amniotic fluid is a water-like substance surrounding the foetus. The foetus grows inside the amniotic sac filled with amniotic fluid during pregnancy. Amniotic fluid contains nutrients, hormones and antibodies which help in keeping the baby healthy. Having low or more amniotic fluid can cause problems for the foetus and the mother⁴

Symptoms 

Symptoms may differ from person to person depending on the severity of the abruption but in some cases, symptoms may not occur. Some common symptoms are: 

• Abdominal pain
• Uterine tenderness
• Continuous uterine contraction (which may feel similar to labour contraction)
• Back pain
• Decreased foetal movement
• Vaginal bleeding (this may not be seen in every condition and, in some people, the bleeding will not be visible because the blood will be trapped between the placenta and the uterine wall)

Diagnosis

The gynaecologist, the doctor who examines a pregnant woman and the health care provider will ask questions regarding previous pregnancies, medical history, and any accidents or trauma that may have occurred. 

• Physical examination: The doctor or the healthcare provider will examine the abdomen for tenderness and an internal examination of the vagina and cervix is done using a speculum
• The foetal heartbeat is monitored
• A complete blood test: This is to check for blood loss
• Ultrasound: It is an imaging modality using sound waves to produce images of the structures inside the body. It helps in diagnosing the disease condition and helps in treatment

Management and treatment

Treatment is planned according to the stage of the placental abruption and the condition of the mother and the baby: 

• Mild cases: Early on in the pregnancy if the baby is not in any distress and there are no signs of vaginal bleeding, the doctor may allow the patient to go home and ask to continue bed rest
• In moderate cases: Early on in pregnancy if there is vaginal bleeding, the doctor may recommend staying in hospital until the baby is old enough for safe labour
• If the foetus is not close to term and there is only partial abruption, the healthcare provider may advise staying home and rest. The doctor may prescribe corticosteroids to help the foetus’ lung mature. The doctor will monitor the baby and mother very closely
• If the foetus’ health condition is deteriorating the doctor may suggest immediate delivery
• If the foetus is near-term and healthy, the doctor may prescribe corticosteroids to mature the foetus's lungs whilst also monitoring the health of the mother and baby closely
• If placental abruption is severe the doctor may suggest immediate delivery through c-section⁷

Complications of placental abruption

Placental abruption is a life-threatening condition for both the mother and the child, some of the complications may include: 

Maternal complications

• Severe blood loss (may be visible or not visible)’ which may cause:
  • Haemorrhagic shock: constituting an increased heart rate and low blood pressure
  • Multiple organ failure
  • Maternal death
  • Prompt blood transfusion
  • Management through hysterectomy⁵
• Blood clotting

Neonatal complications

• Premature birth: It is when the neonate is born too early before the due date. Pregnancy lasting for 40 weeks is known as full-term pregnancy. The definition of preterm birth is considered when the baby is born at 37 weeks or earlier
• Stillbirth: A baby dies after completing 20 weeks of pregnancy. This usually occurs within, mostly in the uterus, and rarely happens during labour⁶
• Restricted growth due to a decrease in the supply of nutrients and oxygen

FAQs

What causes partial placental abruption?

Partial placental abruption may occur due to certain risk factors like maternal high blood pressure, abdominal trauma and usage of drugs. Without proper treatment, partial placental abruption can be life-threatening to both mother and baby.

Can a baby survive a partial placental abruption?

Partial placental abruption occurs when the placenta partially detaches from the uterine wall. This is a mild case where vaginal bleeding is mostly not present. Proper care should be given at this stage, if untreated it can lead to complete placental abruption.

What are partial and complete placental abruption?

Partial placental abruption occurs when the placenta detaches from the uterine wall partially. Complete placental abruption occurs when the placenta completely detaches from the uterine wall and this leads to severe vaginal bleeding.

What happens to the baby after placental abruption?

Placental abruption can lead to restricted growth of the foetus due to insufficient nutrients and oxygen. It may also cause premature birth.

Does bed rest help in case of placental abruption?

Doctors may suggest bed rest in conditions of placental abruption to avoid any bleeding or stress to the uterus. In case of any high-risk condition is present the doctor may suggest bed rest to avoid miscarriage or preterm delivery.

Can a mother survive after placental abruption?

In case of partial or complete placental abruption, there may be a need for caesarean section delivery to save both the mother and the child. In a severe case of bleeding to save the mother, the doctor may need to remove the uterus (hysterectomy).¹⁰

Summary

The placenta removes wastes from the foetus’ blood and attaches the foetus to the mother’s uterus. In partial placental abruption, the placenta partially separates from the uterus causing bleeding, abdominal pain and complications during pregnancy and delivery. This condition can cause a decrease in oxygen and nutrient levels in the foetus.

Placental abruption may cause early delivery and when left untreated can endanger both the mother and baby's life. If the foetus is not close to term and there is only partial abruption, the healthcare provider may advise staying at home and bed rest and the doctor may prescribe corticosteroids to help the foetal lung to mature. The doctor will monitor the baby and mother very closely. If placental abruption is severe the doctor may suggest immediate delivery through c-section.