Placental Abruption

Table of Content

• Types of Placental Abruption

• Signs and Symptoms of placental abruption

• What causes placental abruption

• Complications of placental abruption

• Diagnosis

• Treatment of placental abruption includes:

• Prevention of placental abruption or abruptio placentae

• Conclusion

• FAQs on Placental Abruption

Introduction

Placental abruption or abruptio placentae is a serious medical complication during pregnancy, it refers to a condition when the placenta separates from the uterus. Vascular structures delivering oxygen and nutrient supply to the fetus are compromised. It can be due to high blood pressure or substance use leading to uterus stretching. The uterus is elastic and the placenta is stable. Stretching causes the vascular structures tearing that connect the uterus wall to the placenta. This condition usually occurs before 37 weeks gestation.

Types of Placental Abruption

Placental Abruption is classified based on the following:

Based on class

• Class 0:

Asymptomatic (presence of blood clot, retrospective diagnosis).

• Class 1:

Mild (None to mild vaginal bleeding, slight uterine tenderness, no fetal distress)

• Class 2:

Moderate (none to moderate vaginal bleeding,  uterine tenderness with tetanic contractions, changes in vital signs, fetal distress, hypofibrinogenemia)

• Class 3:

Severe (none to severe vaginal bleeding, Tetanic uterus, Maternal shock hypofibrinogenemia and coagulopathy, fetal death)

Based on detachment:

• Partial placental abruption:

The placenta is not completely detached from the uterine wall.

• Total placental abruption:

The placenta is completely detached from the wall of the uterus. Vaginal bleeding occurs.

Based on bleeding

• Revealed placental abruption:

Vaginal bleeding is moderate to severe.

• Concealed placental abruptions:

Vaginal bleeding may not occur and even if it occurs it is mild. Blood is trapped between the placenta and uterine wall.

Signs and Symptoms of placental abruption

Symptoms are seen during the third trimester. They are:

• Bleeding

• Pain in abdomen

• Back pain

• Uterine contractions are long and intense

• Uterine tenderness.

• Less fetal movement

• Vaginal bleeding 

• Mild cramping 

What causes placental abruption

As mentioned by Schmidt; et al and colleagues, the following are the main causes of placental abruption:

• Health history including behavior, past gynecological history, situation in current pregnancy (multiple gestation pregnancies, polyhydramnios, preeclampsia, sudden uterine decompression, and short umbilical cord)., trauma (fall, violence, accident), history of high blood pressure

• Lifestyle factors like a history of smoking

• Drug abuse history, consumption of cocaine during pregnancy.

• Age is the top consideration during pregnancy as advancing maternal age, especially over 35 increases the risk of placental abruption.

• There are many risk factors for placental abruption including Fibroid, blood clotting disorder, accident, abdominal trauma, infection of amniotic fluid, premature rupture of membranes.

Complications of placental abruption

• Increases risk of maternal morbidity and perinatal mortality. 

• Hemorrhage (bleeding)

• Blood transfusions,

• Hysterectomy

• Renal failure. 

• Preterm birth 

• Low birth weight

• Anemia

• Blood clotting issues

• Growth problems

• Stillbirth

Diagnosis

The following are the important points to consider while the diagnosis of placental abruption is established. Diagnosis and Tests of a placental abruption include:

• Patient personal history including history of trauma to abdomen, cocaine, substance use

• Past medical history including previous history of placental abruption

• Physical examination: 

• Inspection for vaginal bleeding

• Sonogram for  placental location 

• Blood investigations like CBC, fibrinogen, and clotting profile, blood group.

• Urine tests

• Continuous electronic fetal monitoring 

• Ultrasound examination to determine the placental location 

Treatment of placental abruption includes:

• IV fluid and supplemental oxygen on arrival to hospital.

• Continuous monitor of the mother and the fetus.

• Delivery in case of class 2/class 3 classification

• Emergency cesarean due to signs of fetal distress

• Maintenance fluids and circulatory volume during surgery.

Prevention of placental abruption or abruptio placentae

• Avoid substance use like cocaine

• Avoid alcohol and smoking

• Consult a dietician to make wise and healthy food choices

• Follow a healthy lifestyle

• Maintain blood pressure

• Maintain a healthy lifestyle to prevent chronic diseases.

• Prevent falls and trauma. Use a comfortable footwear and avoid wearing slippery footwear.

• While driving wearing a seat belt.

• Be alert always if you find any evidence of bleeding, contact your doctor immediately.

Conclusion

What is a placental abruption? Placental abruption, also known as abruptio placentae, is a serious obstetric complication associated with fetal distress, maternal shock and other complications. Age above 35, high blood pressure, previous history of abruption, and smoking are the risk factors associated. It is essential to recognize its risk factors and clinical presentations to manage the condition effectively and mitigate its severe consequences.