What is a placental abruption?

Placental abruption happens when there is bleeding behind the placenta, between the placenta and the wall of the uterus (womb). This may be just a small amount of bleeding. But if you have a large amount of bleeding, the placenta may partially or completely separate from the lining of your uterus before your baby is born.

Placental abruption can be a serious condition for you and your baby. A large amount of bleeding can be dangerous for you both and can deprive your baby of oxygen and nutrients.

Unfortunately, placental abruption increases the risk of your baby:

  • being born prematurely
  • having growth problems, if the abruption is small and goes unnoticed
  • being stillborn or dying in the first 28 days of life

Placental abruption is diagnosed in up to one in 50 pregnancies. It’s most likely to happen in late pregnancy, or when you’re in active labour.

What causes a placental abruption?

No one knows exactly what causes placental abruption, but it has been linked with many other conditions, including if:

  • You had placental abruption in a previous pregnancy.
  • You have pre-eclampsia.
  • You have bleeding in early pregnancy.
  • You have a blood disorder which increases the likelihood of blood clots (thrombophilia).
  • Your unborn baby isn’t growing as well as he should be (intrauterine growth restriction).
  • Your waters break early.
  • You have too much amniotic fluid (polyhydramnios).
  • You have had a trauma or blow to your tummy, such as from a car accident or domestic violence.
  • You smoke or take drugs during pregnancy.
  • You have had many babies, or are an older mum-to-be, as your risk increases with age.

How can I tell if I’m having a placental abruption?

In about 80 per cent of cases placental abruption causes some vaginal bleeding. This ranges from a small amount to an obvious and sudden gush. The blood may be fresh red blood or old blood that’s dark in colour.

Sometimes, though, the blood stays in the uterus behind the placenta. So you may not see any bleeding at all, but have pain in your back or belly. Some mums describe the pain of a small abruption as being like a bad bruise on an area of their bump. A large abruption will feel very painful, with your bump feeling tense and firm.

If you have any signs of a placental abruption, you need to go hospital for an examination. Call your doctor or the delivery suite of your hospital immediately if you have any of these symptoms:

  • vaginal bleeding or spotting
  • if your waters break and the fluid is bloody
  • tenderness or pain in your belly
  • back pain
  • frequent contractions, or a contraction that doesn’t end
  • your baby isn’t moving as much as before

Call 999 if you’re losing a lot of blood and have signs of shock such as feeling weak, faint, pale, sweaty, disoriented or if your heart is pounding.

How is placental abruption diagnosed?

It depends on how large the placental abruption is, and how severe your symptoms are.

If you and your baby are very ill, the first thing doctors will do is carry out emergency treatments to keep you safe. Doctors will give you oxygen and fluids, and even a blood transfusion if you’ve lost a lot of blood.

Once your condition is stable, or if you are stable when you get to hospital, your doctor will gently palpate your abdomen. She will feel how hard it is and check whether you’re having contractions, and if so, the frequency of the contractions.

As your bleeding may not be from your uterus, your doctor will examine your vagina and cervix. This is to see if the bleeding is from an infection, a tear, a cervical polyp (a non-cancerous growth), or something else.

Your doctor will also check to see if your cervix is opening (dilating). If your cervix is dilating it can disrupt small blood vessels and result in some bleeding.

All the while, hospital staff will monitor your baby’s heart rate to see how he’s doing. You’ll probably have an ultrasound scan to check the placenta. The scan may not detect a small abruption. But it may reveal a blood clot behind the placenta and rule out placenta praevia, another cause of bleeding in the uterus.

If your blood group is rhesus negative and you have vaginal bleeding in your second trimester or third trimester, you’ll need an injection of anti-D immunoglobin.

What will happen if I have a placental abruption?

It depends on how near to your due date you are, how severe the bleeding is, and whether there are signs that your baby is in distress.

You may be admitted to hospital so doctors can find out more and keep an eye on you both. Your doctor may advise that your labour is induced. Or if it’s best for your baby to be born straight away, your doctor will recommend an emergency caesarean.

If you have a suspected abruption but the bleeding stops and you and your baby are doing well, you may be able to go home. However, you will need to return to hospital if you have any further bleeding or pain, or if your baby is moving around less. If you have a small abruption close to your due date, your doctor is likely to recommend that your labour is induced.

It may be safer for your baby to be born, even if it means your baby would be premature. But if your doctor suspects that you have a minor abruption, you may be able to delay the birth for a while. This is provided you and your baby are doing well and there is no further active bleeding.

Your doctor will help you to weigh up the risk of a worsening abruption against the risk of premature birth.

Your doctor may give you steroids in case you do have to have your baby too soon. Steroids speed up the development of your baby’s lungs and can protect your baby from other problems.

Occasionally, some mums and babies become very ill as a result of placental abruption. If you have lost a lot of blood your doctor may ensure you receive oxygen, extra fluids and a blood transfusion. Sadly, some babies don’t survive the trauma of placental abruption, and are stillborn. Rest assured that this is a rare event, and is very unlikely to happen to you.

How can I prevent another placental abruption?

If you’ve had a placental abruption in a previous pregnancy, it does increase your risk of it happening again. You have a one in 25 chance of it happening in your next pregnancy, increasing to about one in five if you had it in two previous pregnancies.

Unfortunately, you can’t necessarily prevent a placental abruption from happening. But some steps may help to reduce the chances of it recurring:

  • Go to all your antenatal appointments, so that your midwife can ensure your blood pressure is under control. She may prescribe you with drugs to lower your blood pressure if it’s too high.
  • Protect your belly physically by wearing a seatbelt, no matter how slowly you are travelling.
  • There are lifestyle changes you can make to protect yourself and your baby. Don’t smoke, as this increases the risk of placental abruption and other pregnancy complications. It goes without saying that taking illegal drugs is harmful to you and your baby, but cocaine and speed in particular can cause placental abruption.



About Daddys with Angels.

We began as a group for grieving fathers and men in families, but other family members asked to join us. We now also have a group for Families with Angels dads and other male family members and siblings under 18. We have experienced and live with the harsh pain of loss and we hope we can bring other comfort with what we do, To find us please search for us on face book or Hugs to you all and floaty kisses to all your angels. We retain the name Daddys With Angels.
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