Placental Abruption

Placental abruption or abruption placentae is a serious complication of pregnancy wherein the placenta, the sack that holds and nourishes the baby as it grows, peels away from the walls of the uterus, partially or completely, before the baby is born. For the mother it causes excessive bleeding and for the infant it can cause a deprivation of oxygen and nutrients. The extreme bleeding it causes can bring on shock and even fetal death. While very serious, it is uncommon, occurring in only 1 out of every 500 – 750 births. Placental abruption causes approximately 22 still born babies each day in the United States. Babies that survive this malady are often brain damaged.

In some cases, the area of placental attachment can hemorrhage after delivery. If the loss of blood cannot be controlled and stopped, a hysterectomy must be performed. Maternal death rates in these cases are extremely uncommon but not unheard of. Especially if there is delayed diagnosis and treatment which does increase the mortality rate for both mother and infant.

There are a variety of reason that placental abruptions happen and strong risk factors that increase the chances. For instance, alcoholism and extreme alcohol intake during the pregnancy can cause placental abruption. Other risk factors include:

• High blood pressure or hypertension in the mother during pregnancy. Studies have shown hypertension present in as many as 50% of these cases in the United States.
• Past instances of placental abruption
• Older mothers
• Uterine distention
• Diabetes mellitus in the mother
• Several prior pregnancies and delivery
• Smoking cigarettes
• Cocaine usage

Some cases of placenta abruption, it is caused from abdominal trauma. Trauma to the abdomen can occur in any number of ways including a big fall or a harrowing car accident. Another way it can happen is from a sudden and immense loss of uterine volume which happens when a rapid loss of amniotic fluid occurs as in the birth of a first twin. An unusually shortened umbilical cord can also cause a placental abruption.

It is imperative that the doctor is informed of any of these criteria during the pregnancy and well before delivery is due. There are a few signs to look for symptoms of placental abruption that may appear as a warning to alert doctors. Those symptoms include:

• Nonstop contractions
• Sharp back pain
• Abdominal pain and cramps
• Vaginal bleeding

If any of these symptoms or signs are present there are several tests that be ran to determine if placental abruption is an issue. CBC tests can tell if hemoglobin or hematocrit has decreased and if platelet count is healthy and safe. The mother must undergo an entire physical examination to decide if uterine tenderness is present and if there is increased uterine tone. Other tests include a prothrombin time test, partial thromboplastin time test, fibrinogen level test, abdominal ultrasounds and a nonstress to determine signs of fetal distress.

To treat placental abruption, doctors must employ intravenous fluid replacement and blood transfusions along with stringent monitoring of the mothers state for signs of shock and fetal distress.