Placental Abruption Causes, Symptoms, Ultrasound, Treatment

The link between the placenta and the uterus is what determines the health of the baby. This link should thus be maintained to the very end of the pregnancy.

However, when the uterus and the placenta separate partially or fully before the birth of the baby, it is a condition referred to as placental abruption.

What is placental abruption?

Placental abruption pictures
Placental abruption – source Tommys

Usually in the 1st, 2nd, 3rd trimesters…

Placental abruption is the partial or full separation of the placenta from the uterus. This is a potentially dangerous condition which can cut the supply of oxygen and nutrients to your baby since the placenta has that duty.

  • This abruption can also lead to bleeding which will increase the health risk to your child.
  • It occurs in about one in every 150 pregnancies and quite common in the third and final trimesters.
  • It is very unlikely that it will occur in the first trimester.
  • The most common occurrences of this kind of abruption start from the 20th week of your pregnancy which is in the second trimester.

Generally, the risk of this abruption goes up from the 20th week of the pregnancy and is highest in the final trimester. However, the level of risk is not equal in every pregnancy since there are many factors which determine whether you will have it or not.

Partial abruption

There is abruption of the placenta either partially or fully.

The full version of it occurs when the whole of the placenta is separated from the uterus. This is the most dangerous type of abruption since it will fully cut the link between the mother and the child. The child will thus be starved of nutrition and other aspects that rely entirely on the link with the mother.

Partial abruption occurs when only a small part of the placenta is separated from the uterus. While the word ‘small’ is used here, partial placental abruption is also a dangerous case mainly because it is more difficult to notice. Hence, it is often late when this kind of abruption is discovered.

Both types of abruption share the same traits and symptoms only with some differences such as the amount of bleeding and pain noted.

Causes of placental abruption

The actual cause of the abruption of the placenta from the uterus is not known. However, the risk factors to this anomaly are well documented.

With this type of anomaly, your doctor will have to know your lifestyle and any other risk factors right when you become pregnant then make a decision on what to do to reduce the likelihood of this abruption.

Signs and symptoms

1. Bleeding

Given that the placenta would be tearing from the uterus, you will experience some bleeding. The color of the discharge will range from brown to pink. If the bleeding is in large amounts, the color will be lighter since most of the blood will be fresh.

The amount of bleeding you will experience depends on which type of abruption you will be having. Partial abruption has less blood and will be mostly constant spotting and less pain.

Full abruption will lead to more bleeding and cramps with other more serious consequences.

An abruption that has bleeding is called a revealed abruption while the one without blood is called a concealed abruption.

2. Pain

Pain during the abruption is felt in the abdomen and the back. These pains are different from what you may normally feel during your pregnancy since they are sharp pangs of pain.

It is the pain similar to what you would feel when you have a tear on your body.

3. Uterine tenderness

Abruption of the uterus comes with uterine tenderness. This is when you feel tender on the sides of the abdomen during pregnancy.

When you become pregnant and as your baby increases in size, you will feel fuller. However, when the placenta and the uterus separate, there will be some space left in the abdomen which will be felt on the outside as a tender spot.

Uterine tenderness during your pregnancy is never a good sign as it shows there is an underlying medical condition.

4. Uterine contractions

If you notice sharp uterine contractions coming one after the other yet your labor is still far off, you should let your doctor know about it.

One of the signs of the abruption of the placenta are these sharp contractions at a time when you are not expecting to go into labor any time soon.

It is the body responding to the change in the structure of the uterus and an early sign of an impeding problem.

5. Slow growth of the baby

Given that the fetus would be partially or completely starved of nutrition, its growth will be slower than an average baby. This can be noted through an ultrasound test and many others which can be used for the same purpose.

As the baby grows, there are expected sizes and other aspects at each stage. If your doctor observes the slow growth of the baby, chances are high that the nutrition could be low. This can be due to physical causes such as a placental abruption or the poor nutrition of the mother.

6. Heart rate anomalies in the fetus

When the baby does not get enough nutrition due to the abruption of the placenta from the uterus, one of the signs is an abnormal heartbeat in the fetus.

This occurs as the little heart struggles to pump the blood faster to circulate it and get rid of wastes from the body. However, given that it would not be fully developed, the heart of the fetus will begin faltering. This can be noted by a doctor using the right equipment.

7. Low amniotic fluid

If a low amount of amniotic fluid is noted, chances are that it could be due to a physical problem in the womb. The separation of the placenta from the uterus will lead to the low creation of the amniotic fluid and other parts of the womb including the baby.

8. Pregnancy complications

The pregnancy solely depends on the link between the baby and the mother. This link is the placenta and the uterus. Through the placenta, the baby gets nutrients, oxygen and protection from diseases while any waste is taken through the same placenta to the mother’s body for expulsion.

If any issue occurs with this link, the pregnancy will be marred with complications which pose a danger to the baby and yourself.

One of the most common causes of these complications is the separation of the placenta and the uterus.

Abruption with no bleeding

While bleeding is one of the main signs of the separation of the placenta from the uterus, there are times when placental abruption does not involve any visible bleeding. This is called a concealed abruption.

In such a case, the abruption can either be full or partial yet you do not have any blood. The blood from the abruption would be caught in the cavity created between the placenta and the uterus.

To identify this type of abruption, your doctor will first look for the signs of internal bleeding such as:

  • Shortness of breath
  • Pain in the abdomen
  • Pain in the chest
  • Bruising on the abdomen sides and around the navel
  • Dizziness especially when you stand up
  • Nausea
  • Blood in urine
  • Vomiting
  • Stool that is black and tarry
  • Blood from other cavities such as anus, mouth, nose and ears.

If not discovered early enough, the lack of bleeding from this kind of abruption can lead to the late death of the fetus. To deal with this case and many others that may put your pregnancy at risk, you need frequent checkups done throughout your pregnancy.

Placental abruption ultrasound (pictures)

The ultrasound pictures of placental abruption show a detailed view of what happens when the placenta partially or fully separates from the uterus. The pictures are cross-sectional perspectives which show a black mass around the womb which represents blood.

Placental abruption ultrasound pictures
Ultrasound pictures: source: Radiopedia

In all the pictures, the blood can either flow to the left or the right of the womb and is a characteristic black against a lighter background.

The same pictures can be used to tell whether the abruption is partial or full and whether it is concealed or revealed.

Besides the use of ultrasound, other methods used to detect the abruption of the placenta include;

  • Evaluation of specific signs and symptoms
  • Fetal monitoring
  • Blood tests and many others.

What are the effects on the baby?

The baby will suffer from the separation of the uterus and the placenta in various ways such as:

  • Heartbeat abnormalities
  • Slow growth
  • Too little amniotic fluid around the baby
  • Abnormal growth
  • Death in some cases

In fact, this kind of abruption will affect the baby more than it will affect you as the mother.

Most cases of the separation of the placenta from the uterus may go unnoticed until when the baby is born or when an anomaly is noted in the pregnancy.

If you have the risk factors to this condition, always let your doctor know for the sake of your baby.

Risk factors

Because the actual causes of the separation of the placenta from the uterus are not known, doctors focus on the risk factors to know what to look out for. The most common risk factors include:

Hypertension

Hypertension can increase the chances of having an abruption of the placenta from the uterus. The most likely cases are gestational hypertension, chronic hypertension and preeclampsia.

If you have any of these conditions, your doctor should prepare for any eventuality that may arise from their presence.

Uterine anomalies

Having problems and diseases that affect the uterus such as fibroids and cancer also make it easy to have an abruption of the placenta from the uterus. Often, the abruption will occur right where the fibroid or anomaly is located.

Age and number of birthday

As you grow older, the chances of having complications with your pregnancy significantly go up. These include increase in the likelihood of having an abruption of the placenta from the uterus prematurely.

Generally, being pregnant from age 35 and above increases the chances of complications compared to pregnancy at a younger age.

Drug and alcohol abuse

Taking large amounts of alcohol and tobacco generally has negative effects on your pregnancy.

Besides affecting the health of the fetus and yourself, these substances can introduce many complications in your body such as the separation of the placenta from the uterus at the wrong time during the pregnancy.

Abdominal trauma

Any trauma to the abdomen including being involved in an accident, being hit in the abdomen by an object and other cases increase your likelihood of having a placental abruption.

Always ensure you are properly checked after any of these incidents.

If you are pregnant with multiples

Having more than one fetus increases the weight of the womb with the likelihood of the placenta being separated from the uterus at any time.

Multiple births are twins, triplets and more. These types of births are rife with complications especially if it is your first time bearing more than a single baby.

Early pregnancy bleeding

Having bleeding during the early stages of your pregnancy will also make you vulnerable to an abruption of the placenta from the uterus.

Too much amniotic fluid

This condition is referred to as polyhydramnios and it is among the main causes of the abruption of the placenta.

When you have too much of the amniotic fluid, the womb would be heavier than expected. This will tend to pull the womb downwards thus putting tension on the link between the placenta and the uterus. The two can thus be separated at any time.

Once you have the abruption, it may lead to having of less amniotic fluid in a condition called oligohydramnios.

Premature breaking of water

When the water breaks before the time for labor, it can lead to the separation of the placenta from the uterus prematurely.

This is a sign that is easy to take note of whether it is your first or subsequent pregnancy.

Blood clotting disorders

If you have any condition which impairs the ability of your blood to clot properly, it will increase your chances of having an abruption of the placenta. These conditions include:

  • Von Willebrand’s disease
  • Factor II, V, VII, X or XII deficiencies
  • Hemophilia A and B

1.    Previous abruption

If you have had an abruption in your previous pregnancies, you are more likely to have an abruption in your current pregnancy.

This means that, when you have had abruption in one pregnancy, your doctor should focus on looking out for the same in the next and subsequent pregnancies.

Treatment

Bleeding during a pregnancy can be a sign of many different aspects some of which do not require the attention of the doctor. The extent of the abruption will determine what steps to take to keep the baby and the mother safe.

The one thing to take note of is that, once the abruption has set in, there is nothing that can be done to reattach the placenta to the uterus.

In most cases, you will be forced into labor especially when you are close to the day of delivery. This is meant to prevent any further abruption from occurring.

A caesarian section may be needed if the baby is being starved of oxygen or you are bleeding too much. This is mean to save both your life and that of the baby.

In other cases, when the bleeding is minimal, the baby healthy and you are some days to labor, you will be simply monitored until the day you go into labor. In this case, your hospital will have a C-section team on standby in the case that it is needed.

In some cases, corticosteroids are administered for their benefits in helping prevent premature birth and hastening the growth of the baby before any further problems set in.

The figures for the intervention methods for the abruption of the placenta from the uterus are quite encouraging given that most end up with healthy births. However, about 15 percent of the cases of placental abruption end up with the death of the fetus due to the complications that come with it.

Getting pregnant after placental abruption

While having an abruption of the placenta from the uterus increases the likelihood of having it in the subsequent pregnancies, this abruption often has little to no effect on your fertility.

Provided the abruption has not affected the structure of the uterus, your next and subsequent pregnancies will be without issues as far as getting pregnant goes.

References

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